HomeMy WebLinkAboutRPZ Test 8/13/13 FROM (THU> 8 18 2013 11:32/ST. 11:28/No. 8001737464 P pp
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-M Club geN TESTING
G I MECHANICAL
Reduced Pressure Zone Backflow Preventer Valve & Pressure Breaker Valve
Rebuild & Test Report
Business: Contact Person/TeL: Date:
F1 Ha wk 1 jam ) 224'— 7 IV:31Z
Address: Cit Zip:
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Make: { 1 � Model: Size: K Send #:
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' of Device: Served what System:
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' Instill Yr.: ' '
Rebuild Date: a
2Qld-
Test Yr. Check Valve #1 Check Valve #2 Differential Pressure Relief
%' Leaked() Closed ()() Did Not Open ( )
23 4 L.eaked() Closed ( �
. 4 1 . ult � �
Install () ` i Pressure : 7f3 Opened At: t •
Pressure : I R cleaned cleaned Cleaned
Replaced Replaced Replaced
E Poppet Poppet � °�
P Spring �
0 Ring Ring 0 Ring
A Rubber Seat Rubber Seat Rubber Seat
I " Other Repairs Other Repairs • Other Repairs
R
S •
Certification
Thereby certify the foregoing data to be ect and that the device tested is functioning `
Within the limits of the standards/6
Signed: Dated: `$'I(3
COW FORD Certification 11066455 -PM I GARY FORD Certification 11058476 —PM 1 ALAN FARR Certification # 066481 BF
Metro Testing/ Metro Mechanical Conadtanta, TL C 31222 Cedar Creek Rd, Hineidey, MN 55037 612- 221.6888
Plumbing Bond License: PC646918 Mechanical Baud Certificate ID: 5054 -MB
This report is for the purposes of recording only; Owner is responsible for safe operation
and upkeep of scheduled maintenance.
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