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American Society of Sanitary Engineering <br />Reduced Pressure Principle Backflow Preventer (RP) <br />ASSE Standard #1013 Field Test Report <br />.1<ITS ;= <br />Owner of Property Shayne Ernzer <br />Address 505 Willow Dr South <br />City Long Lake <br />Occupant of Property (if different from <br />Occupant Address <br />City <br />State <br />Zip Code <br />Manufacturer of Device: Wilkins Model #: 975XL <br />Size of Device: 1" Serial #: 3662618 <br />Location of Assembly and Equipment or System Application: Irrigation System <br />Test Equipment: <br />Manufacturer: Wilkins <br />Calibration Date: 1/10/21 <br />Model #: TG -3 <br />Serial #: 091010878 <br />Date test was performed: 4/2/21 Time test was performed: Static Line Pressure: <br />Certified Tester (print) Dan Swanson Assembly Final Test <br />Address 1880-B West Wayzata Blvd Performance <br />City Long lake State MN Zip 55356 <br />Phone #: 952-473-8793 Pass <br />License #: PJ061307 Certification # 28072 Fail ❑ <br />7 <br />Signature V\.QDate: �f <br />Comments or Recommendations (continue to other side, if needed): <br />Check Valve #2 <br />Shutoff valve #2 <br />Check Valve #1 <br />Pressure Differential <br />Relief Valve <br />Leaking (� <br />Initial Test <br />Leaking (E]) <br />Leaking (EI) <br />Closed Tight (� <br />Opened at s psid <br />Closed Tight (ED <br />Closed Tight (✓[ D <br />Pressure Drop Across <br />Check Valve #1 s psid <br />Describe parts <br />and repairs <br />when needed <br />Leaking (ED <br />Leaking (E]) <br />Leaking (0) <br />Closed Tight (ED <br />Final Test <br />Closed Tight ® <br />Closed Tight (© <br />Pressure Drop Across <br />Opened at _psid <br />Check Valve #1 psid <br />Certified Tester (print) Dan Swanson Assembly Final Test <br />Address 1880-B West Wayzata Blvd Performance <br />City Long lake State MN Zip 55356 <br />Phone #: 952-473-8793 Pass <br />License #: PJ061307 Certification # 28072 Fail ❑ <br />7 <br />Signature V\.QDate: �f <br />Comments or Recommendations (continue to other side, if needed): <br />