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3388 Mike Collins Dr - RPZ Test ReportsRICHFIELD PLUMBING C O M P A N Y JOB ADDRESS (INCLUDE ADDRESS #, STREET NAME, & DIRECTIONAL), Apt/Unit # 33 9jM:kt 86.10 Harriet Avenue, So. Suite 100 Bloomington, MN 55420 Phone 952-881-3355 Fax 952-881-3399 E-mail serviceQrichfielclpituvbing,com BACKFLOW ASSEMBLY INFORMATION (All Fields are Required) System Served: .l.X r c1 �d ✓� Manufacturer of Assembly: Via— --7 Model # Size of Assembly: � � Serial # ! O r � ' / -- q24 Location of Assembly: Floor# / ' l(�. !/l Room # Date test was performed: Reduced Pressure Principle Backfiow Preventer (RP) — TEST RESULTS Check Valve #2 Shutoff Valve #2 Check Valve #1 Pressure Differential Relief Valve Closed Tight Initial Test Closed Tight _Yes _No Closed Tight _Yes _No _Yes_No pressure Drop Across Opened at psid Check Valve #1 psid Describe parts and repairs when needed Closed Tight No Final Test Closed Tight _Yes _No Closed Tight _Yes ^No _Yes pressure Drop Across Opened at psid Check Valve #1 psid Double Check BackfJow Prevention Assembly.(DC) - TEST RESULTS Check Valve #1 Check Valve #2 Shutoff Valve #2 Closed Tight —Yes—No Closed Tight _Yes _No Closed Tight —Yes—No Initial Test psid psid Describe parts and repairs when needed Closed Tight _Yes _No Closed Tight _ Yes _No Closed Tight —Yes—No Final Test psid psid Pressure Vacuum Breaker Assembly (PVB) or Spill Resistant. Vacuum Breaker (SRVB) - TEST RESULTS Air Inlet Valve Check Valve Shutoff #2 Failed to Open —Yes _No Closed Tight _Yes _No Closed Tight X Yes —No Initial Test Pressure Drop Across Opened at psid Check Valve #1 psid `0,L-P— Z �S �� L ��' Describe parts and �.L� t repairs when needed Final Test Opened atpsidPressure Closed Tight A es _No Drop Gros Closed Tight Yes No — Check Valve #1 r psid CERTIF(CATION: I ce ify the foregoing inf rmation provided by me to be correct that the test device is tunctloning with the liLimits or the sianaarus. Name Print): �'V'U� Signature: Date: v State of MN Certificate Number: R tob Iy 7-51:8 Ltf� 7, Ntnv •PC1)44199, )IpI,. 8\l 94 1. Si. Paul alW " Il A� f _IAn 1.,:6'A r XAL Y h /Z RICHFIELD PLUMBING C O M P A N Y JOB ADDRESS (INCLUDE ADDRESS #, STREET NAME, & DIRECTIONAL), Apt/Unit # 8640 Harriet Avenue, So. Suite 100 Bloomington, MN 55420 Phone 952-881-3,955 Fax 952-881-3399 E-mail sereice©richfieldplumbing.com BACKFLOW ASSEMBLY INFORMATION (All Fields are Required) System Served: E Manufacturer of Assembly: Model #� /" L Size of Assembly: �I Z �) Serial # Wi19 Z 4 Location of Assembly: Floor #_ j ` 6b V Room #�� J Date test was performed: L zb 2 I Reduced Pressure Principle Backflow Preventer (RP) — TEST RESULTS Check Valve #2 Shutoff Valve #2 Check Valve #1 Pressure Differential Relief Valve Closed Tight Yes No Initial Test Closed Tight _ Yes _No Closed Tight _ Yes _No _ Pressure Drop Across Opened at psid Check Valve #1 psid Describe parts and repairs when needed Closed Tight Yes No Closed Tight X- Yes Closed Tight Yes —No lC� Final Test — _No Pressure Drop Acr Opened at psid heck Valve #1 I psid I Double Check Backflow Prevention Assembly (DC} - TEST RESULTS Check Valve #1 Check Valve #2 Shutoff Valve #2 Closed Tight —Yes—No Closed Tight , Yes _No Closed Tight _ Yes _No Initial Test psid psid Describe parts and repairs when needed Closed Tight —Yes—No Closed Tight _ Yes _No Closed Tight _ Yes _No Final Test psid psid Pressure Vacuum Breaker Assembly (PVB) or Spill Resistant Vacuum Breaker (SRVB) — TEST RESULTS Air Inlet Valve Check Valve Shutoff #2 Failed to Open_ Yes _No Closed Tight _ Yes _No Closed Tight —Yes—No Initial Test Pressure Drop Across Opened at psid Check Valve #1 psid Describe parts and repairs when needed Closed Tight _ Yes _No Closed Tight _Yes No Final Test Opened at psid Pressure Drop Across Check Valve #1 psid CERTIFICATION: I certify the foregoing information provided by me to be correct and that the to d device is functioning with the limits of the standards. Name (Print): V1J Qy �'L 0.L� Signature: V� Date: 'L State of MN Certificate Number. 13FvG - ` O ..i=1'0: i; 129, Mph. ell-541. /- /} .f `grW v 4 rV CJ P4-e— 0 uve— L1/9 /M �� a � N RICHFIELD PLUMBING C O M P A N Y JOB ADDRESS (INCLUDE ADDRESS #, STREET NAME, & DIRECTIONAL), Apt/Unit # 332 g / 'l kc' Co(h'ks Dy" 8640 Harriet Avenue, so. Suite too Bloomington, MN 55420 Phone 952-881-9355 Fax 952-831-3399 E-mail service@richfieldplumbing.com BACKFLOW ASSEMBLY INFORMATION (All Fields are Required) T ( � —; k t (/� Model # r 7� System Served: —+— � S � Manufacturer of Assembly: "" Size of Assembly: 3 f l Serial # Location of Assembly: Floor #TQ l"W Room # ,w e— b(A test was performed: Zl Reduced Pressure Principle Backfiow Preventer (RP) — TEST RESULTS Check Valve #2 Shutoff Valve #2 Check Valve #1 Pressure Differential Relief Valve Initial Test Closed Tight _ Yes _No Closed Tight Yes No — — Closed Tight _ Yes _No Pressure Drop Across Opened at psid Check Valve #1 psid Describe parts and repairs when needed Final Test Closed Tight X Yes _No Closed Tight � Yes No _ Closed Tight Yes No Pressure Dro A�C,[.Jpss ` Opened at Z- psid Check Valve #1 I 1 psi, Double Check Backfaow Prevention Assembly (DC),— TEST RESULTS Check Valve #1 Check Valve #2 Shutoff Valve #2 Closed Tight —Yes—No Closed Tight _ Yes _No Closed Tight No Initial Test —Yes—No _ psid psid Describe parts and repairs when needed Closed Tight _Yes _No Closed Tight _ Yes !No Closed Tight Yes No Final Test _ psid psid Pressure Vacuum Breaker Assembly (PVB) or Spill Resistant Vacuum Breaker (SRVB) — TEST RESULTS Air inlet Valve Check Valve Shutoff #2 Failed to Open_ Yes _No Closed Tight _Yes _No Closed Tight Yes No Initial Test Pressure Drop Across — — Opened at psid Check Valve #1 psid Describe parts and repairs when needed Closed Tight _ Yes _No Closed Tight Final Test Opened at psid Pressure Drop Across _Yes _No Check Valve #1 psid CERTIFICATION: i certify the foregoing info mation provided by me to be correct an that the test e device is functioning with the limits of the standards. % (Print): Print: "" Name e R Signature: Date: State of MN Certificate Number: _--55�►T - 1 - - - _ ----- --- -- xv- - W_. u, =rcrtiie. tNis.a> aai.s.r: ininuas , ram'`/I �Y(�r���C\ �.. �.. EAGAN 3830 PILOT KNOB ROAD EAGAN, MN 55122-1810 L HYDR*COR P THE SAFE WATER AUTHORITY, Cross Connection Control Program Testing Notice EAGAN BUILDING C/O JGM AGENCY Print Date: 04/06/2022 1224 WEST 96TH ST BLOOMINGTON, MN 55431-2606 Dear Water Customer, please provide this page(s) to your tester. ATTENTION TESTERS ONLY: This correspondence addresses testing of backflow prevention assemblies. Following completion of testing and/or repairs, all test results must be submitted online at gethydrosoft.com. Test forms will no longer be accepted via mail, fax or email. A onetime registration process must be completed by each tester before any test results will be accepted. Testers will be required to provide the reference number listed below upon submission of test results for each facility where testing has been completed. If you have questions or require additional information please contact HydroCorp at 1-844-493-7641. Completed test forms are to be entered online by 05/31/2022. RE: EAGAN BUILDING at 3388 MIKE COLLINS DR Reference #: 741-BBE-B10 Device Protection Manufacturer Model Serial # I Size I Test Date I Test Status RPBP Isolation Wilkins 975X1-2 4217154 1 0.75 2� 2 j Not Tested Location/Comments: Supply to DI system In warehouse. Line PSi: T5 P -/�T CV1: q �` CV2: J�� RV: RPBP Isolation Wflkins 975 XL W438245 1 0.5 2(1 27 Not Tested Location/Comments: Supply to fume hood 1 In lab 5. Line PSI: -7,S s = CV1: Z CV2: r , b RV: VB Lawn Sprinkler System Watts 800 M4 109111 1 ` y Not Tested Locatlon/Comments: Lawn Sprinkler System In sprinkler room. Line PSI: -/�` _ AIV: CV: 2 (� a