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, A RECEIVED <br /> • :; MECHANICAL JUN 29 2012 <br /> -i' <br /> 4 CONTRACTORS CITY OF ORONO <br /> __....._M,_- ST. PAUL, MN 122 S.Wabasha St.Suite 101, St.Paul,MN 55107 Office 651-777-0001 Fax 651-602-9296 <br /> REDUCED PRESSURE BACKFLOW PREVENTER TEST REPORT AND <br /> TESTABLE DOUBLE CHECKS <br /> Service Name: Met Council Contact Person/Tele: Chuck Lamere <br /> Address: 110 Orono Orchard Rd. City: Orono State: MN Zip: <br /> Device Location:L-60 (by meter tank) Serve what system: Potable water <br /> Account Number: Serial Number: 28241 <br /> Type: RP Make: Watts Model: 009 Size: 1 1/4" <br /> Install Date: Unknown Air Gap Installation Date: <br /> Rebuild Date: 6/5/2013 Test Date. 6/22/12 <br /> Annual Check Valve#1 Check Valve#2 Differential Pressure Relief Valve <br /> Report Pressure 8.0 Pressure 5.2 tight Opened at 4.4 psid reduced pressure. <br /> Did not open❑ <br /> ❑ C• leaned Cleaned ❑ Cleaned <br /> ❑ R• eplaced ❑ Replaced ❑ Replaced <br /> R Disc ❑ Disc ❑ Disc, Upper <br /> E ❑ Spring ❑ Spring ❑ Disc, Lower <br /> P Guide ❑ Guide ❑ Spring <br /> A Pin Retainer ❑ Pin Retainer ❑ Diaphragm, Large <br /> 1 n Hinge Pin ❑ Hinge Pin [ Lower <br /> R ❑ S• eat 0 Seat ❑ Upper <br /> Diaphragm TI Diaphragm ❑ Diaphragm, Small <br /> S _ <br /> Other, describe ❑ Other, describe ❑ Lower <br /> ❑ Upper <br /> ❑ Seat: <br /> ❑ Lower <br /> ❑ Upper <br /> ❑ Spacer, Lower <br /> ❑ Other, describe <br /> [®] Sign and date Tag <br /> The above is certified correct. Signed <br /> DateTested 6/21/2012 <br /> Tested by (Print Name) Sween Pearson' Certification Number 063817BF <br /> License Number 058169PM <br />