HomeMy WebLinkAboutRPZ 8/9/2011 Page 8 of 23
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ETROT'1ESTIN LLC.
E -Mail: MetroTesting.LLC @Gmail.com
Visit us at: www.RPZtesting.com 1 www.MetroTesting.net
Reduced Pressure Zone Backflow Preventer Valve & Pressure Vacuum Breaker Valve
Rebuild / Test Report
1.1
Business: ' flaw Sc # 719 Contact Person/ Tel: y E : 7' '-
G �M AYY - DELLW : 9121
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Address: City: Zip:
5061 MINNESOTA STREET SE. PRIOR LAKE 55372
Make: WATTS I Model: 00913 f Size: % Serial #: 117 981
Device Location: t Served what System:
BOILER ROOM BOILERS
Install Yr: Rebuild Date:
NIA 8I 2009
(Every 5'h Yr. is required to be Overhauled/Rebuilt, MNAdndn Rule: 4715.1161.)
Test Yr. Check Valve # 1 Check Valve # 2 Differential Pressure Relief
(Circle One) Leaked( ) Closed ( St) Leaked( ) Closed (1() Did Not Open( )
1 3 4 p
Overhauled ( ) Pressure: Pressure: 0 • d Opened At: c e
R Cleaned Cleaned Cleaned
E Replaced Replaced Replaced
P Poppet Poppet Poppet
A Spring Spring Spring
1 O Ring O Ring O Ring
R Rubber Seat Rubber Seat Rubber Seat
S Other Repairs Other Repairs Other Repairs
Certification
I hereby certify the foregoing data to 9 g
correct and that the device is tested is functioningwithin the limits of the standards.
• Dated: 0 - l c� 0 / (
Signed
by : GARY FORD Certification # 058476 -BF or COLE FORD Certification # 066445 -BF
F i rm Name : Metro Testing/ Metro Mechanical Consultants, LLC Ad d r es s : 31222 Cedar Creek Rd, Hinckley, MN 55037
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This report is for the purposes: Recording Only; Owner is responsible for safe operation and upkeep if scheduled maintenance. $
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