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HomeMy WebLinkAboutTest report/Interstate testing-2012 2012-05-12 16:59 INTERSTATE TESTING 7637555365» +9522494616 P 1/2 Interstate Testing 2140141 Ave NW Andover MN 55304 � Phone Number (763) 744-6149 Fax Number (763) 755-5365 Email interstatetestina!a��omcast.net FAX TRANSMITTAL. FORM To: G� � O.-a•, a Pk�J,c From: Donn Miiler _ _ c,v�.�ks Date: S� /2—�.� Fax: 1 s'�. 2 y� cf6�� Number of Pages: Z Message: / � I°z � s�-• r.���r� �'v�- �J•, ���� ��.;h � �•�� � �.�-k-� I�vJ�hn�e fv.��� t�/uv�s If you should receive this fax in errvr, please notify Inter�tate Testing at (763) 744-6149 This fax is intended to be viewed only by the person or people listed on this fax. 2012-05-1217:00 INTERSTATETESTING 7637555365» +952Z494616 pZ/Z Cross Connection Control Device PerfoRnanse Tsst Interstate Testin9 Z1d0144st Ave.NYV. Andover Mn. 66304 Phone(T83)7d4-6148 OYVNER INFORMAT O��r r, , �bwtllddMs �(Il N•�,-4,_ �Ol W r1 � h a b OwIN�'i�bMid PMson 7M�phnw Nur�b�r � � rFA�CN.�TY�IFOIiMATION �a 8restAddnds � r �- � � 9 ��-a' S 1 V! �'1 /� —"� � �Coa Ca�n4► O 6 � ��� _ .. _ CN ( � c..� � �} ? � �� �.� st� �y Ty� o,�oe��or o oc a oc n.a�or o PversvB , wn�u.�s�r � �� p Cb,ed tlpht �RP raYsi valva �L � PS�D U opsn StMic ' � PSID Sm� PSID Oid not .. •--------------------------•-----------------------------------------............................__..._...................._..---------•----------- EJIIAL OC1owa�ipn,t ❑Goaa apnc Operwa� PSIO Stalk PSIO � S�C PSID o�tECrat s�P�ss A3�tH1�.r iw'r�A6 t�t Q�� O�AOC�� RP rdMl alrs � ❑L6aksd [�L6oltod lJ Oid not open 94nk PSID S�lic PSIO ................................................................................----------------.............__..........................-----•---- DETEG?OR B1�PAS8 ASSEYBLY FN�41L TEST S4�c � PSIO Slidc � PSI� �°1�at P31D P�VAC'WMI�1lEAI�!N�1fAL TE'iT ; P�VA�CWM ellFJII�'R FINAL 1EST �iAk W�t whie �� �er�ed at PSID ❑�M ;�Opa�ed at PSIO O CbN�!dpht u de r+o�cpen O�.oleae � sfa�le PS�o . � PSIO ' COMMENT9 � � ��t�i�� yl q r` �-►�'4��te`�� � �U� ��-�ti-� � . .... .,_.. ._ ., �_ � I HEREBY CERT'IFY THE TEST RESULTS ARE TAUE ANO THE TEST WAS CONDl��C____BY I�AE PERSONAI.LY. Testa►Name(print) c:'�� I�'I.� f��e.s� Registralion No.D 6�3� �3�m+e d Oay � . r�er si�neturs o � .+-r� Phons No.76�, .. . oabe J J t �Z, '�t/C� (�,I�L�j Jun. 05.2015 01:37 PM Interstate Testing 763 755 5365 PAGE. 2/ 2 ��ws�..�,,- Ccos� Cannec�tion Gontro! De�i�e �er�orman�� T�s� In�erstat,� Te�ting ��ao 1a�A�e. riww. Andaver Mn. 66504 Rhane(T63)744-6149 t�WN�R INFQR AT � l'�. �,�A�t r�l ` .x� ���� �y h!��r� C. `�--'� � Cor�lacA Person 'iebpfxx�e urt�t�ar �J�b' 1\,,�$i n.� �rB �l i l <(Cl n1 � �ES� � `Y'�d � ! ! �R�i�����AT� R AI�m9 Eh'est Addl'Ns � �^" ,k.. +-�'1 q �^-'•m, (J i�'l � � 2'AQ CfiAb Coun�r c C�, • �.� � R �. NW� �� �� ��--�--^^� �,�.r � �.¢�.� �' � `'� � � 8i� ��'y.� 1'� D RP p�tsetor � DC C1 DC�r 0 PV'�/SVI� . ��� � �� --- �M a�ned� _ 3- y �� C3 t,eac0a �t�ced Cl n�d�op�r► �lC _�,�,�,�..,�.�,,,�Psio............... S�c_ c�Cr-_�SIO....�.....__.�.._ .. ._....._......_-- --•-•--....___------- Cb�O� �Cbsetl tfyM Operied at PSIp Sl�lc PSIp S�iG F�SfD DET'�CT'OR BY'PABS A�S�M9LY MII'1'U1L T�iT � RP roNeF a�lw .h�.�� �� U Old not open. ._..��� P�D Smtic PSID Static FS�D ._----_m___..___--••--------•--_.._.........-----•----------�-------------------•---------•-----•--....---•-------------------------........__.._:- �CY'OR BYPAS�ASSEMBI.Y PtMAL 7SST ❑cios�d t(ghc a c�ed�gnr op�.d ac -- - - P81� 34ttlC PSlD St�tiC_ --_--_. F►S10 Pi�$SURE VAdil� 7'E�T ; PR!!l�URE VACl1U�1�AK�R F1NAl, O�ened at F'SEq �M .�O�sr�ed� PSiD �M � oPen Sta�liC__,„..,,_ f�81p �ati� P8[Q � COMMEiHT8 � - ._. _ _. �� y3�ir' I HER�BY GERTI�Y THE T�37 RESIJLT8 ARE TRU�AND 7H�7�ST WAS CONUU E P�R80NALLY. re�s�r,��nt� �,� � �.a F�egied'atiart No.�'�o�3�3 R 7�7'Irs�e of Day �-�_ / �� T�3lpnat,ure ��� �-�G�„ Phone Na: !o data � 7�'`� �/�`� � 2013-06-05 12:00 INTERSTATE TESTING 7637555365» 9522494616 P 212 Cross Connection Cantrol Deulce Performan�e �`sst Irtterstate Testing 2i40144�t Ave.NYV. Astidover Mn.66304 Phona(763)744-6149 QWNfR fHFOlRMATfON ,�____,_.,� Owner , 9treet AOd►eas �vt' v�..-�. �w�� ` 1 s ��7 `7`� �y n l�,.-�. c � ��e Gode Owns�`a Contact Pe�son 1'ebphoix� �xr�er r� � ,"�v9 r n � /�'1 •�0 �2 LlJ, � �1�. �� { G>' � �.�d� � 7 5 I FACKlTY MFORMATlON F ' Nw7w r . ' Strs�t AdOreBY � ~` �� � �-s�L W�--=� S � � f i.J�I1Cy�'`�s� � i1P Cotl� Ga� y •-C C. � ���� 3lriaf N1sri�r ".x (.n,1 � L �..�, � °! 7 `� �._ �` YS�e .� t` Aas�bly ty� P L1 RP Da�tsctor � DC C] DC Ustector d PVB/SVB wrrw.�s�r �S� `� ���� LJCJos�d tlphR LJGlpsed tipht el PSID p L9ake0 �L�a�ked �++Ot op�n Static P31D �Ilc P&ID s�I�A�...........................•-•--•.._.._.---------------...••••.........------•----..........---------•----•-'--.....-----...-�----•- ..�"�"� L�C�aaa+�y►n ope��ea�t 3 � �s�o S�tic PSID static Ps�o c'1�Y'ECTQft atr�A�sa A�lell.Y nyr�lAL TEST' RP ro�d�hra (�CbMd 1fpM Q C,'loesd lipht �►�at f�SID ❑t�saked ❑La�kk9d U[7�d not open St�tic PS1D Siatic PSIO ..-------------------------------------------------------------------------------••-------------•-------•----------------------------------------•- DETECTOR dYPASa A�Y FMIAL 1'E�T ❑CJond ffpM Q Cbsed tipht Opaned at .. , PSID 9mtic PSID StaCc P510 PRE�1lIt�V�M!!!1lEAKHt IMt1AL 1�T ; Pi�88Uli�VACUUM!lI�AK�R FNiAL'�'T � �s�o o�M ;'c��� -- ---�s�n �no"� ��o SE�tic P510 COMMENTS � .... Il'S f.�► S/,p�. �.,�h d�..ih y �� �-r�s-r �.7� �r� �h�is-sy4��.. %Csy4�,,, I HEREBY CERTIFY THE TEST RESULTS AR�'FRU�AND THE TES7 WAS CQNDUC'TED BYME PERSaNALLY. Tester►�me(print) ���;, ►� /�'1 � 1�� � Reqis�atlan No.v��i"3-�3 �7�ri�ae ot Day rester s+�turs �'�o'--�. �`j,-�-��L Pnona No.�4�3 -- �aoe -(� Y�/3 ��!`( <v/�' ! Jun. 10.2016 03:10 PM Interstate Testing 763 755 5365 PAGE. 2/ 2 � Cross Conne�tion Contr�pl Dev�i� P�r�orman� Tasx intersta� Test�ng �1�4014'1�t/�ve. NW. Andovar Mt�,6630a Php�te{7$3) 7A4-6149 �� DWNER tNfb A7 -•.------- W ��+ � � $�7� �yh����-� G �N v4 �,. �u r� `' x �1..�..r�,...�. +►d oa►e ''r�a W�:�licx �ti ���� 3� 7 �! 1 ��x.mr w�oroa � F �leme r . , Sh+eet Addnee8 � r- ,�y�� .�Q,.. 6 �'yl �Cl�yr. . � V f � r+V "'�� ZtP Cods Oou»Q' _... ._.0''d'►"1.G _� ` �. _..__.,.__. ��..���' �I� I"'' '1�-�-�i w t�,- _ ....,....--W---..r- �1�J' Z �L/'�!. � '7 '7 `'�^"- IVumbp��� s6��^,, Aaa+�Anbty T�qa P �#tP t�s�tsc�or ❑ uc Q ��eor d PvelSlre lNf1tAL,T� � V�reqet vaive oadd tiptrt s9d tlght OpgrW�d 8t � �� PSID . 17 Leakecl t7 C3 Ls�ke�d �D1d not apon st�ac � ' Psia stat� a_��:-� _ Psia --------------------------------------------------------------------------------------•---.......--•--- ...................................... C7 c�,�a►�a�he ❑c,aoaen nam oae��ea ac psin s�c psi� soa�c r�s�o o�c�r�wt�w�►ss��.�r��rru►��a�r D��ht �tiar►t ��a�ot�ope� �� �tlo P81D SFatle PSID .................,.......�..............�------.,.---•------�---------......._............__...................................-•---�----.........._,. pE'M'RC7'ipR�1rPA0a A89EM81.Y;fsMiAl.TZc�Y Cl Clt�eqd tl�t1R ❑C1osAd dpM Opsned at PSID �tiC PSlD $l�tic pSID p V'Aq1UM dREA1�R MIRIM�. T ; V �t Pt F{NAL 7�8T , �7p�� __ . P51D �h1 c�c?pengq ay t� PSIC� '�Cbs�tlpht LJ Old+wt open� laeak�ed 3t�ic 6yS{O � Saalllo p81p � . coa�M�rs " I N�REBY CERTIFY TH�7�'T R�3Ul,TS ARE TRU�AND THE TES7 WAS CONqU = ���RSdN�u.,I.Y. Te�t�er N�me(print) %�a r, �. /?'l : t��e.r ��rauan Na.n����� R?�'-���,e or oay I ,/� 4•�. /� T�c�sro��,� Cn/C�'✓� / �-a- Phane Ne.7G.��_,,�_..._� .. Qate CD�`�id 7y'��i�'g 2014-05-22 14:30 INTERSTATE TESTING 7637555365» 9522494616 p Z/Z �'(/`+�G►'ti/' Cross Connection Control De�riCe Perfonnan�e Tss� Interstate Testing 214�144st Ave.NW. Andover Mn.55944 Phone(763)744�-6149 �R q�iFQRMAT 4wner , 9traet+A�dd'aee /� - ��, ��11 �i�l"�i i 7 � !• r./ / �7`7 •`�'y�l l�/r� C- � $� �C.00S �N110/�Ci011�PY�80n tO�Opf1011p l�'��..4 n •e � ,,,,1 �� 1�1V, �1 e► .,� t � G y � �.�37 7 `7 1 F�1'r WFORAIATION F t�Lms .�_.__..,��.._... Etreet Maras� � �--� -� � `'''� �i �•-y � U:h ' r'1 .�'� $Caee Ca�mb c� G + A869f1'�`p��G . (JL �� � / �J�..� j �f�rs � 7 y �_ � Yj Srr�e� as�b�r�e n Rp oe�r o ac O ac Daaaor Q�versvs �t+rru►�ns�r . �� RP neYeir vah�e � �� L.S pid nfit- - - PSID Statle P31D $� pg�p � .._...... ----------•--.._.... ... --•---- ---•-- •----------------------------------------- SS�Ydc �- � � ----- --.....��ed�--3� ��;,�'—'—. � -- c �a �rc asiu D�T�C'1�OR BYPA�A�.Y MWTIAL'f'E�sT L1� � RP t�f�odvs Q C�d!i� Cbdid tlpyt ��at PSiD CJ L�6�kld 0 L9eked U Qi4 nOt apen S'l�fc PSID StatlF i'SID ...------------------•------...............------------------------------------ ._.......__....._..-•------------------- ..... -------------- - ..,.•-;- o�rt�cro�t t���e�r FMuc r� ❑Closed Mpht p Clo�p 1f�t pp�� pg�p Sb�ic PSID SIaNc PSID PR�IMIE VAd!!JM�Al�t NIfAL T�3T ; Pl1E�IJNE YApAlM MEAK�1t fM1AL 7�T � � ;idN 4deR�a1vs Ooe�+ed ac �u o c�oMa�M ;�ope�+ed ec Ps�o �np� Q ad aa op�n O�-�wa�d � 9talk____. _PS�D �e�k PSID CCMMENTS ' y'�` Gj�4�. ��5� I HEREBY CERTIFY THE TES7'R�SULT3 ARE TRUE ANO TME TEST WAS GONDUCTED BY ME p�RSONN.LY. Tester Narne(priAt) /_l�.t� 1 ���� Rep�0i1 No.�fo��-�3 �rTN1ie Of Oay � /�'�-�.�.� 7 3 ••_•„ „— r� d t yo reNer sgr�a�re �'�c� Phons Mo. (p - �y���y°S