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M ETR OMC HA N ICAL LLC.
E -Mail: MetroTesting.LLC @Gmail.com
Visit us at: www.RPZtesting.com I www.MetroTesting.net
Reduced Pressure Zone Backflow Preventer Valve & Pressure Vacuum Breaker Valve
Rebuild / Test Report
1.1
`.r '� r Co nti/ fek -`°e Date:
Address: City: Zip:
5304 WESTWOOD DRIVE PRIOR LAKE 55372
Make: WATTS I Model: 909 QT L Size: % I Serial #: W602 867
Device Location: Served what System:
BOILER ROOM BOILERS
Install Yr: Rebuild Date: 17/- 2 e) ' 1
WA 81 2006
(Ever 5. Yr. is required to be Overhauied/Rebuilg MNAdmin Rule: 4715.2161.)
Test Yr. Check Valve # 1 Check Valve # 2 Differential Pressure Relief
(Circle One) Leaked( ) Closed ( Leaked( ) Closed ( )0 Did Not Open( )
1 2 3 4
Overhauled (■ Pressure: / ' Pressure: )7 Opened At:
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 forego/ data be correct and that the device is tested is functioning within the limits of the standards.
Signed: ,,..., ( Dated: / • /3-?0 (1
Tested by : GARY FORD Certification # 058476 -BF or COLE FORD Certification # 066445 -BF
F i rm Name: Metro Testing/ Metro Mechanical Consultants, LLC Address: 31222 Cedar Creek Rd, Hinckley, MN 55037
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o This report is for the purposes: Recording Only; Owner is responsible for safe operation and upkeep if scheduled maintenan
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Rev 74011