05.25.23Interstate Testing, Li.0
P.Q. Box 5S
Anoka, MN S5303
(763) 744.61149
interstatetesting0comcast net
Backflow Assembly Test Report
(RPZ, DCVA, PVB, SPVB,)
City: ^ Fridley -
Property/Owner Information
Property Name.
Christenson Crossing
Property Address:
Adder
151 Christenson Ct. N.E.
city;
UAW
7ifp,
Fridley
MN
55432
Property Cotttaet/Phone#;
Name:
Phone:
Ryan Allord
(612) 750-2660
Property Owners Address.
Address:
2855 161 st Ave. N.W. Andover MN 55304
City:
sestet
ZIP:
Andover
MN
55304
Property Owner/Phone #:
Name:
Phone:
Well Groomed Lawns
612 750-2660
Type of Assembly/Work Performed
RPM;
PVB
SPVB
MA
Test X Repair RB
Test --_Re ir_Ril
Test Re it RH
Test _-_Repair RR
Backflow Assembly Information
Size:
Makes
Model.
Serial
&Iftm Serviced:
2"
Wilkins
975XL
3401837
Irrigation
Location ofAssemblyr Doghouse on corner
Backflow Assembly Test Results
Type of
Cheek Valve #11
Shut off Valve #2
Relief Valve/
Check Valve #2
Assembly
Air inlet Valve
Rn
Opdn Closed X
Upen.__-__ Closed X
opened art. 3.n psid
Open_ Closed X
Pressure tiff. 9.2 psid
Did not open
OCVA
open . Closed -
Open �._ . Closed
Open - Closed
Premare OffL _ psid
Prarxsue a Dflt... p;dd
PVB/SPVB
Open _ Gowd
opened at _psid
Upon Closed
Pressure 011 _ paid
slid not open „
CQTnI1IME1tt3f,
PASS FAIL _
Tester's Information
Tester's Name:
'Tester's Signature.-
Certification #:
Gate;
Donn Miller
BF065323
05-25-23