HomeMy WebLinkAboutBackflow Preventer Test Report •
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J• MCAT
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1257 Marschall Road, RO. Box 237 a Shakopee, Mil 55379 .
. Phone: 952/445-5100 Pax:'952/445-5119
BACKFLOW PRE', ENTER TEST REPORT
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JOB ADDRES DE ADDRESS#,STREET
{NAME,&DIRECTIONAL),Apt/Unit#
kgaBCKal14SSEI OTAA4a_urerta- rerm �. �PAIR
System Served:/e///e, )0, / Manufacturer of Assembly: t , /A "i Model#
Size of Assembly: / Serial# 36,2(5 i. 7
Location of Assembly: iVeato4 ,,C,tdf.i Floor# Z L Room# Date test was performed:i iC3 V66.
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Check Valve#2 Shutoff Valve#2 Check Valve#1 Pressure Differential
Relief Valve
Closed Tight Yes No
Initial Test Closed Tight X Yes_No Closed Tight Yes_No pressure Drop Across Opened at psid
1 Check Valve#17,4/ psid
Describe parts and
repairs when needed
Closed Tight _Yes No
Final Test Closed Tight _Yes_No Closed Tight _Yes_No Pressure Drop Across Opened at psid
Check Valve#1 psid
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K��, � _ '�� '" �� ` '' � r DoublekGheckFBack�lor�v Prevention Assembl a�1jDC1 TESTRESULTS��y ..t� �..�: 1�- :�3��_
414
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Check Valve#1 Check Valve#2 Shutoff Valve#2
Closed Tight _Yes_No Closed Tight _Yes_No Closed Tight _Yes_No
Initial Test
psid psid
Describe parts and
repairs when needed
Closed Tight Yes No Closed Tight _Yes_No Closed Tight _Yes No
Final Test
psid psid
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x '� x Pressure'Vacuum Bre ker:Ass RA (PVA)or.Spill_Resistant l/acuurn 6„reaker(SR�/B�V ST,IRESCI ta.�:: : ,AC
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Air Inlet Valve Check Valve Shutoff#2
Failed to Open Yes_No Closed Tight Yes__No Closed Tight _Yes_No
Initial Test Pressure Drop-Across
Opened at psid Check Valve#1 psid
Describe parts and
repairs when needed
Closed Tight _Yes_No Closed Tight Yes_No
Final Test Opened at psid Pressure Drop Across
Check Valve#1 psid
CERTIFICATION:I certify the foregoing information provided by me to be correct and that the tesovice is functioning with the limits of the standards.
/ ' v Si nature: o ` Date:
Name(Print): ��- ��l (`;')/ /� � g �.
State of MN Certificate Number: 7 9 ?2-7---
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