HomeMy WebLinkAboutRPZ REPORT 8/31/2010 FROM CTUE) 2 8 2011 12:24l3T.�2:21fNo.S00�73T369 P 11
IVletro Testing
312�2 Ced�tr Creek Road
Hinckley, M1ti155037
612-221-5888
Backflow Freventer Test Report
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Owner; ,,,� „� �! q Ca act Person/ Tel. Date: �, �� o
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Address: City: e� Zip:
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Ma�Ce: Madel: c � Size: � ►� Serial:
�'� 1 �3 � / f l '� 7 �
Locatian of �fevice: Se�rves what System:
f �o . �L+2,. �D�vt �'� , •
Test Year Check Valve #1 Check Valve #2 Differential Pres. Relief
�� Leal�ed( ) Leaked( ) Did Not Open �
t�- � Closed (1�1 � Clased (dr� `� °� .
+ Pressure �t �� Pressure �`� p ened At °� b
C�ea�ed Cleaned Cleaned
R � Replaced Replaced Rep3�ced
Poppet Pappet Diaphragm
� Spring Spring Sprittg
P " O lting Q Ring 4 Ring
� Rubber Seat Rubber Seat � Rubber se�t
Other Repairs fJther Repairs Other Repairs
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Certi�icatian
I�eceby certify the foregoing data ta �e carxect d that t e c�evice t ted ius £ux�ctiaa.iuxg
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Within the limits of the standards signed:_,_,_����'�✓ _
Firm Name: Metro Testin� 31222 Cedar Creek Rd. Hincklev. 55037"
Tested 13y: G�ry Ford Ce�rt�ific�,tinn # 05847b-BF QR Cnle Ford Certi�iication # 66445-BT
This repart is for the purpases�Recording only; Clwner is responsible for safe operatinn
And u ke of scheduied maintenance.