HomeMy WebLinkAboutRPZ Tests
NlETRO TESTING
31222 Cedar Creek Road
Hinckley,:MN 55037
612-221-5888
Backflow Prevenler Test Report
Annual Testing
ofR.P.Z. Valves
\
.
Address IIi&xJ J:;b/~ Av€
City . H'~/2 ~
ZiP.$'555:>
Owner ~t~4/ ShroeuJ Telephone # Date 11-/~d.5
, Make and modeJ of Device ,W, 1,It.,,J.s r7S J(L Size / :{.'. Serial # "8>/9563
Location of device )~#". t7AI2 f'" 4"\H D. ~
'-i Check. Cheek va! ve Pres dif across ~fwben Strainer
c3 ;-}4z valve # I #2 # J Check relief opens
Test Leaked ( ) Leaked ( ) psi psi None~
Closed / ~ f"lose .J ,- 12- 3.1 crnd ( )
.~~ '$.-.-T
.0
Final Test
. -
Final Tesl Leaked ( ) . Leaked ( ) _p:il _psi
Closed ( ) Closed ( )
.
Malenals
used
Certification
I hereby certify the foregoing data to be correct and that the testes device is functiDning within the funiC! of the
standards
.
Firm Name Metro Testin~ Address 31222 Cedar Creek Road Hinckley, MN 55031
By Gary Ford Tester's Certification #1649T Tel No. 612-221~5481
Date
RCLll~ks
BJmq d~8:G~ SO VA ADN
~'d
8v9o-v98-0G~
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NDV-07-2006 11:49
CITY OF PRIOR LAKE
Metro Testing
31222 Cedar Creek Road
HinckJey, MN 55037
612-221-5888
Backflow Preventer Test Report
B 0 95~42~
l(-6~
City:
il. r~'rz.... t.. ~ l:L
Size: ! ')L "
Serves what System~
I4~A9-I
Date: Ie; -3 ;-0;5
Zip:
Owner:
Cont,act Person! TeL
7 7 ~ X.L
Serial: ?/7 5b ::s
Location of Device:
R
E
P
A
I
R
S
Check Valve #1
Leaked( )
;~~::~~ 1. ()
Cleaned
_ Replaced
_Poppet
_ Spring
_ 0 Ring
Rubber Seat
Other Repairs
Check Valve #2
Leaked( )
Closed~ n "'0
Pressure (, 0
Cleaned
_ Replaced
_ Poppet
_ Spring
_ 0 Ring
Rubber Seat
Other Repairs
Differential Pres. Rdief
Did NotOpen__
o ened At 'S.2
Cleaned
_ Replaced
_ Diaphragm
_ Spring
_ 0 Ring
Rubber seat
Otber Repairs
Test Year
Certification
1 hereby certify the foregoing data to be correct and that the device tested is functioning
Within the limits of the standard.~
Firm Name: Metro Testin~ 31222 Cedar Creek Rd. HincJdev~ MN 55037
Tested By: Gary Ford CertificatioD # 1649T OR Cole Ford CertifiCAtion # 2243T
This report is for the purposesIRecording only; Owner is responsible for safe operation
And upkeep of scheduled maintenance.
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laJnel
eot; L L 90 90 ^ON
TOTAL P.04