HomeMy WebLinkAboutRPZ TEST 8/30/2010 FROM �TUE) 2 S 207Y 12:231ST_�2:21fNa.$00173T369 P 7
Metro �'esting
31222 Cedar Creek Y2oad
Hin�kiey, M�155037
d1.2-221.-5888
Backflaw Preventer Test Repart
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Uwner: ,.—�� y .� Contact Person/ Tel. Date: �� „ tU
Address: City: Zin:
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Make: At'�a M+�del: ��,r,� �,,,�, S�ze: �/� �' Seria�:
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Locatio�a of Device: Serves x�hat System.
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Test �ear Check Valve #1 Check Valve #2 Differ�ntia� Pres. Relief
T �� Leaked( ) Leaked{ ) Did Not �pen
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Closed (a+� C�osed (�
1 Pressutre � � Pressure �• � Q ened .At �• �
Cleaned Cleaned Cleanerl
R Replaced Replacec� Replaced
Poppet Foppet Diaphragm
� Spring � Spring Spriu�g
p o �n� � �� o ��
A l�ubber Ses�t Rubber 5eat � Rubber seat
Other Rcpairs Other Repairs Uther �t.epairs
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Certification
Y hereby certify tbe foregaing data to be correct a d that the d�vic _ tested i.s functioning
Withi� the limits of the standards signed: w� ����„�„�
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Firm Name: iV�etro Testin� 3�.222 Cedar Creek Rd. Hinckle�MN 5503'7
Tested By: Gary Ford Cextification # 0584'�6-BF UR Cole Ford �ertification # 66445-BT
This report is for the pur�ses/Reco�ding oraly ()wner is responsible for safe operation
And u kee of scheduied mr�.intenance.