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COMPLIANCE INFO
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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MURPHY
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22241
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1600 - Food Program
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PR0521818
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COMPLIANCE INFO
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Entry Properties
Last modified
11/24/2020 2:52:10 PM
Creation date
9/3/2020 4:27:02 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
RECORD_ID
PR0521818
PE
1632
FACILITY_ID
FA0004488
FACILITY_NAME
RIPON USD-COLONY OAK SCHOOL
STREET_NUMBER
22241
Direction
S
STREET_NAME
MURPHY
STREET_TYPE
RD
City
RIPON
Zip
95366
APN
24518035
CURRENT_STATUS
01
SITE_LOCATION
22241 S MURPHY RD
P_LOCATION
99
P_DISTRICT
005
QC Status
Approved
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Tags
EHD - Public
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./5/2020 05 : 20 PM PST TO : 12094640138 FROM : 2092532090 Page : 2 <br /> ,tato City of Ripon <br /> o Public Works Department <br /> + . ¢ 259 N. Whom Avenue <br /> CITY OF RIP Ripon;Ca 95366 <br /> (209)599-2151 <br /> °rareaj9uh BACKFLOW PREVENTION DEVICE Fax(209)599-2183 <br /> . ..TEST REPORT <br /> Owner Name/Address: Service Name/Address: <br /> Ripon Unified School District Colony Oak School 1 <br /> 304 N.Acacia Ave. CA 95366 22241 S. Murphy Rd. CA 95366 <br /> Manufacturer WILKINS Model 375AST Size 4 Serial# 11142 <br /> Device Location By the tank. North device. <br /> ❑ New Device ❑ Temporary ❑ Replacement - Old Serial# <br /> Reduced Pressure Principle Assembly RP DCDA o <br /> DC ❑ RPDA <br /> Double Check Valve Assembly SVB ❑ PVB ❑ <br /> Check Valve#1 Check Valve 42 Relief Valve PVD/SVB <br /> Held at G•(P PSID Held at PSID Opened at 2-1- PSID AIR.INLET <br /> }. <br /> Leaked Q Closed Tight {� Opened at PSID <br /> Leaked ❑ Did Not Open ❑ Did Not Open ❑ <br /> w ❑ Cleaned ❑ Cleaned ❑ Cleaned CHECK VALVE ❑ <br /> o <br /> ❑ Replaced ❑ Replaced ❑ Replaced Hold at PSID <br /> 7. Disc , Disc _ °iso ❑ Cleaned <br /> r _ Spring _ Spring _____ Spring <br /> 5 °'u Guide _ Guide Dia hra m El Replaced with: <br /> ro P g <br /> �j Seat Seat Seat Type: <br /> 4 Module _ Module _ Module Mfg: <br /> W p O-Ring _____ O-Ring O-Rin <br /> Other Oth©r g <br /> — . Other <br /> Q N Closed Tight ❑ Closed Tight ❑ Alt Inlet PSID <br /> z <br /> LL H .PSID PSID Opened at PSID Check Valve PSID <br /> Comments; <br /> Da#e 2-- <br /> IN O Tim jCerifi Tester No 10872 Passed ❑Failed <br /> j�'lllAO'` Paul Ha <br /> (Signafare) � K 1Y WP. Print Name- P <br /> Date Time Certified Tester No. 10872 <br /> �-� Repaired 8y(Signature) Prnt Name. Paul Hampton <br /> Date. Vrrte Certlfred Tester.No. 10872 ❑':"Passed❑ railed <br /> F Tested By(ftpatura) PrInf Naive Paul Hampton, <br /> Received Time Jan. 5. 2020 5 : 18PM No. 5772 <br />
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