Laserfiche WebLink
ASS E I nternational <br /> Pressure Vacuum Breaker Assembly (PVB) <br /> ASSE Standard #1020 Field Test Report <br /> Owner of Property M&M HOMES <br /> Address 4220 CHIPPEWA LN <br /> Clty ORONO StatB MN Zlp COde 55315 <br /> Occupant of Property (if different from owner) <br /> Occupant Address <br /> City State Zip Code <br /> Manufacturer of Assembly: WILxtivs Model #: �zo-a <br /> Size of Assembly: 1" Serial #: cBis22so <br /> LOCat1011 Of ASSeI'Tlbly and EqUlp171ent Of SySt@1Y1 AppllCat1011: IRRIGATION-VACUUM BREAKER LOCATED ON <br /> EAST SIDE OF HOUSE <br /> Test Equipment: <br /> Manufacturer: wtLxiNs Model #: T�-5 Serial #: o3ios435 <br /> Calibration Date: NEw <br /> Date test was performed: 12/17/2016 Time test was performed: 2:30 PM Static Line Pressure: 65 <br /> Leaking ( ) <br /> Opened at 2•2 psid Closed Tight (X ) Leaking ( ) <br /> Final Test Pressure Drop Across Closed Tight (X ) <br /> Check Valve#1 3.7 psid <br /> Certified Tester (print) COLLIN KING Assembly Final Test <br /> Address Po sox si Performance <br /> City cxas� State MN Zip 55318 <br /> Pass x� <br /> Phone #: 952-334-2794 <br /> License #: PM064313 Certification # ASSE 32700 MN BF064313 Fail ❑ <br /> Signature `"`� ���'' <br /> Date: 12i1�i2ois <br /> Comments or Recommendations (continue to other siae, if needed): REQUIRED TO TEST ANUALLY <br />