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American Society of Sanitary Engineering <br /> Reduced Pressure Principle Backflow Preventer (RP) <br /> ASSE Standard #1013 Field Test Report <br /> Owner of Property City of Orono <br /> Address P.o.eox ss <br /> Clty Crystal Bay Stat2 MN Zlp COd@ 55323 <br /> Occupant of Property (if differ nt from owner) <br /> Occupant Address �• � (� GC/'�C�Q <br /> City 0�'��B State /v Zip Code <br /> Manufacturer of Device: Watts Model #: 919QT <br /> Siz� of Device: 2" Serial#: 2683$ <br /> Location of Assembly and Equipment or System Application: Main water suppiy in water sortener room. <br /> Test Equipment: <br /> Manufacturer: W�ikins Model #: TG-3 Serial #: os�o�os�s <br /> Calibration Date:o2i�si2o�5 <br /> Date test was performed: $/2/20�6 Time test was performed: 11:00 AM Static Line Pressure: <br /> Check Valve#2 Shutoff valve#2 Check Valve#1 Pressure Differential <br /> Relief Valve <br /> Leaking (� <br /> Leaking Q]) Leaking Q]) Closed Tight (� <br /> Initial Test Closed Tight (� Closed Tight (� Pressure Drop Across Opened at_psid <br /> Check Valve#1 sid <br /> Describe parts <br /> and repairs <br /> when needed <br /> Leaking (� <br /> Leaking �]) Leaking �� Closed Tight (� 3 <br /> Final Test Closed Ti ht � Closed Ti ht � Pressure Drop Across Opened at_psid <br /> g � g � Check Valve#1 8� sid <br /> Celtlfled T2St@f (print)Dan Swanson Assembly Final Test <br /> Addf2SS 1880-B West Wayzata Blvd Performance <br /> Clty Long lake Statg MN Zjp 55356 <br /> Phone#: <br /> 952- 3-8793 Pass � <br /> License : Pcsaa s Certifi ation # 28072 Fail ❑ <br /> Signature � Date: 8/2/2016 <br /> Comments or Recommendations (continue to other side, if needed): <br />