HomeMy WebLinkAboutBackflow Preventer Test Report 2013 CORVAL GR
BACKFLOW PREVENTER TEST REPORT
DATE: ) ' � ' /3
Site Name:C6 1.2 c, i y p f Job # 1 J ' &3 00
Site Address: 13.1? 1' I,i- L (._lu2._ TY U. 1 City: p/'/) i /- et k Zip Code: S5 5
Contact: P l 1 - PC9e.1 Phone #: ,aid_ --
Owner: ' M MCA �LL( Rsv I I V. Phone #: Lai ' ?j-'` - 8 - 409
Owner Address: `3 g5Q T (i I(i�1Dt f1 j S Cit ,Jfas U i (k Zip Code: (55539'
Make/Model of Device: (Mitt, 4.5 (M9 Size: it Serial #:
Serves What System: A50 / .-I—, ( I Location: w1 Cciux.. ' cc1 / ic7 d ‘
Ck Valve Pres. Dif. Across Pres. Dif. when
Ck Valve #1 #2 #1 Ck relief opens Strainer
Leaked ( ) Leaked ( ) None ( )
Test before Repair Close ( ) Close ( ) PSI PSI Clnd O
Describe Repair
Final Test Materials Leaked ( ) Leaked ( ) None (4,
Used Close OC) Close OC) 9 O PSI 3 ' PSI Clnd ( )
CERTIFICATION:
I hereby certify the foregoing data to be correct and that the tested device is functioning within the limits of the
standards.
FIRM NAME: Corval Constructors, Inc. ADDRESS: 1633 Eustis Street St. Paul MN 55108
BY: •Ti J CERTIFICATION #: C G X35_ PHONE: 651- 645 -0451
DATE: " c L 1 % 3 REMARKS:
( ) INSTALL (X TEST () REBUILD ORIGINAL INSTALLATION DATE:
DATE OF LAST REBUILD: a U 1