PBV 06.08.23Interstate Testing, LLC
P.O. Box SS
Anoka, MN 55303
(763 ) 744.6149
tnterstatetesting0comcast.net
Backflow Assembly Test Report
(RPZ, DCVA, PVB, SPVB,)
City: — - -- - - Fridley
Property/Owner Information
Property Name:
Terr Re es Residential
Property Address:
Address
1479 N Danube Rd.
City:
State.
ZIP;
Fridley
MN
55432
Property Contact/!Phone#:
Name:
Phone:
Terr Re es
763 571-8385
Property owners Address:
Address:
1479 N Danube Rd. Fri&L MN 55432
City"•
Statt,.
7Ap:
FridleX
MN
55432
Property Owner/Phone #:
Name-,
Phone:
err Reyes Residential
763 571-8385
Type of Assembly/Work Performed
RPZ
PVB
SPVB
DCVA
Test -L Repair... RB
Test Repair RB
Test _ _,. Ito -air RB
Test — Repair RS
Backflow Assembly Informations
Size;
Make:
Model:
I serial! M.
System Senlced:
1"
Watts
LF009M3
L 382631
Irriagtion
Location of Assembly. In basement, by meter
Backflow Assembly Test Results
'!(ape of
Check Valve #1
Shut Off Valve #Z
Relief Valve/
Check Valve #2
Assembly
Air Inlet Valve
RPz
Open Closed �_X
Open Closed X
Opened at 3.2_ Pad
opt'ir _ Ctnsed X
Pressure Diff. 9.0 od
D14 not open
DCVA
Open_Closed..,....._
Open_ Closed_
vpeti Closed
Pressure 011t—psid
Pressure t?1fI ,,__,_.,,,,,- psid
PVB/SPVB
opea "wd—
ppeftedat�.�.,,Psld
4�peo Closed
Prmu re 011T. — psid
Aid not open
Comments:
PASS_X RAIL_.__.._.
Tester's Information
Testers Name:
Tester's Signature:
Certification
Date:
Donn Miller
BF065323
06-08-23
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