HomeMy WebLinkAboutRPZ Test 2025 - 2670 Kelley ParkwayREDUCED PRESSURE BACKFLOW PREVENTER TEST REPORT OR
TESTABLE DOUBLE CHECKS
Service Name: Contact Person/Tele:
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Address: 7y ��C%� is City:
State:
Device Location: Serve what system.
Account No: Serial Number:
Type: �/��
Make: /I/'' �' Model: t2 Size: c;�
m
Rebuild Due Date:
Annual
Report
Test Due Date:
Check Valve #1 Check Valve #2 �� �" Differential Pressure Reiiet valve
Pressure v' Pressure T� Opened at psid reduced pressure.
Did not open 1.2
Cleaned
Cleaned
Replaced
Replaced
R Disc
Disc
E Spring
Spring
P Guide
Guide
A Pin Retainer
Pin Retainer
I Hinge Pin
Hinge Pin
R Seat
Seat
S _ Diaphragm
Diaphragm
Other, describe
Other, describe
t_(] Sign and date Tag
The above is certified correct. Signed
Tested by (Print Name)
Todd Maul
Cleaned
Replaced
Disc
Spring
Guide
Diaphragm, Large
Lower
Upper
Diaphragm, Small
Lower
Upper
Spacer, Lower
Other, describe
DateTested
f^�
Certification Number 067999BF
201 10001591
Company Name: Cities I Plumbing and Heating Inc
License Number
Company Telephone Number 651-274-6547
All sections of this report must be completed.
Return to: Saint Paul Regional Water Services Fee per Device
ATTN: Mollie —Engineering $ 35
1900 Rice St
Saint Paul, MN 55113
Fax: 651-266-6287
E-Mail: Water-PlumbingPermitApp@ci.stpaul.mn.us
*$35.00 testing fee will be applied to customer's water bill