HomeMy WebLinkAboutRPZ 7/7/2011 'age 2 or 23
METR N G,
OME , 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
BaSinesi:Pitolt L 0* ,NM# 710 Ccmtacf Person! " 'Iret: " < k1t 1
AVE RA E IiI "
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Address: City: Zip:
11620 FIVE HAWKS AVENUE SE. PRIOR LAKE 55372
Make: WATTS I Model: 009 QT I Size: % I Serial #: 411 496
Device Location: Served what System:
BOILER ROOM BOILERS
Install Yr: Rebuild Date:
WA 81 2007
(Every 5 Yr. is required to be Overhauled/Rebullt, MNAdndn Rule: 4715.2161.)
Test Yr. Check Valve # 1 Check Valve # 2 Differential Pressure Relief
(Circle one) Leaked( ) Closed (\() Leaked( ) Closed (X) Did Not Open( )
1 2 3 V
Overhauled ( ) Pressure: 70 Pressure: C. `1 Opened At: 02 c l
R Cleaned Cleaned Cleaned
E Replaced Replaced Replaced
P Poppet Poppet Poppet
A Spring Spring Spring
I 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 be correct and that the device is tested is functioning within the limits of the standards.
Signed: Dated: - ' oC
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
o This is report is for tke purposes: Recording Only; Owner 1 responsible for safe operation and upkeep if scheduled maintenanc
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