HomeMy WebLinkAboutRPZ TEST 8/31/2010 FROM fTVE� 2 8 20Y1 12:24/ST.12:211No.$00�73T3B9 P 72
Metro Testing
31222 Cedar Creek Road
Hinckiey, MN �5037
612-221-5$8$
� r ,,, Backflow Preventer Test Report
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Owner: � ,.� I ,� ontact Person/ Tel. Date: � ,� � � �
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Address: �! ,� � ,�' City: Zip:
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Make:� � 1V,�ade1: � � Si�e: ,/� �� Serial: ,/�,t
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Locatian of Device: Serves �vhat System:
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Test Year Check Vs�lve #1 Check Valve #2 Differential Pxes, Relief
� Leaked( ) Le�ked( ) Did Not Open
� � Closed (pr� e � �losed �}
'� �"' Pr�sure � �. L� Pressure �. � Q �p�� �� �, �
Cleaaaed CYeaned Cieanec�
� Replaced Replaced Replaced
Poppet � Poppet Diap�rr��m,
� Spring Spring Spring
� O Ring U Rang O Ring
A Rubber 5eat � ltubber Seat Rubber seat
Other Repairs Other Repairs Other Repairs
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Certification
T hereby certify the foregoing data to be correct and th�� tb�� vic tested is unetioning
Withi� t�e limits of the standards signed: �
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Firm Name: Metro Testing,�31222 Cedar Creek Rd. Hin.cklev, MN 55037
Tested By: Gary Ford Certi�catian # OS847G-BF OR Co1e Fard Certi�ication # G6445-BT
This report is for ths purpasss/Recording only; Qwner is responsible fox safe operation
And u kee nf scheduled rnairitenattce.