HomeMy WebLinkAboutRPZ test report OINNERC/AL
UMBING AND HEATING
R P Z TEST REPORT
Site Address 6 y r To.7 /<e wg I?d• 01-040 )�14.
Owner/Occupant C:g."n ji T',•ko
Device Location c t-1' f y 2 0 0 A-7 Floor/Room# Qvse'rca�
System Served t•e�
Make k/,lk,n s 7_&.,n Model # 1 7,-r' XL Serial# /Y?8'O 8'2 Size �(
Install Date iC-,s=o.3 Overhaul Date Test Date 6-S'- O 3
Test #1 Check Valve #2 Check Valve Pressure Diff. Pressure Diff.
Before Leaked _Leaked across#1 check when opening
Repairs X Closed 8:6 Y, Closed `l.O PSI 3.8'" PSI
Final
Test _Closed _Closed PSI PSI
Describe Repairs 5i-4r f ug f e 5 f
Tested By ,I l-10^1 Certification Number O! y 5/;)'-'
COMMERCIAL PLUMBING & HEATING
24428 Greenway Ave. N.
Forest Lake, MN 55025
6514642988
16-SEP-2008 12:44P FROM:LONG LAKE PUBLIC WKS 952 4762856 TO:9522494616 P.1
uair41Au14 WVY.L
ROTO ROOTER PLUMBING SERVICES CO.:
BACKFLOW PREVENTION (RPZ) TEST REPORT
14530 27th Avenue N.
- Plymouth, MN $5447
763-559-3522
Customer jdg:r Device Location -d -
Sita Address es�i�/.#�ij�- ��• System Isolated &WW" ti r
Clwstata .-, Q,If� ZA64�.� __ Install Date AJ 7
Contact Person A ` Z Overhaul Dale 9t
Phone Number 67—fe7/— OW17 Test gale
Type of Assembly: RPZ❑ DCV❑ _ ,
Make Model Sial Number Size
New Replacement, If applicable:
Make Madel Serial Number size
CHFECK VALVE 01 RELIEF VALVE CHECK VALVE 62 CHECKVALVE92
BACK PRESSURL CONFIRMATION
❑ Leaked Opened at: .._ psi ❑ Leaked p Leaked
❑ Closed tight Did not open ❑ Closed tight ❑ Closed tight
Dfte ytial`Ifri d ii ia' .. ❑ ' ....'�_.. .— _-OiRerentlal pressu�e--� _ �M'erentl0Vresas+re-'• -�-, •-
psi psi psi
❑ Cleaned only [] Cleaned only [) Cleaned only
Rept cad; Rd: Replaced:
Rubber kIt rRubberldt Rubber kit
CV assemblyV assembly C1/aesembty
or disc edisc error disc
04ings 04NI; 0-rings
seat KSeal tj Seed
❑ spring ❑ sw ng ❑ spring '
❑ S'tewdGuide 0whragm(s) []'8*WGulde
0.tomer, OUw. pey. ❑ Otar,vw fy:
❑ Other,*&W. ❑ 011w.spew. ❑ 011ier,speo�y
Final lost after repairs: Opened at Final WtFinal�te�st�
._�— psi _... iPsl --0-1� ISI
Comments
r.
I hereby oertiy that this date is aoarrata end reflects the proper operation and maintenance of the assembly.
tester-*Name: .•/ .It/ License#-Certification ti< 9�/�V l7'?r'
Teller's Signature: Date: _-. A/0" _
Master Plumber; pave Lohmonn 2695PM t