HomeMy WebLinkAboutRPZ Test 8.14.13 FROM <THU) 3 13 2013 11 : :20/No.0001737404 P 0,0
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TESTING
MECHANtCRL
Reduced Pressure Zone Backflow Preventer Valve & Pressure Breaker Valve •
Rebuild & Test Report
Business: Contact PenontFeL: Date:
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Address: City ZAP:
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Make: . 1 ^ i Model: ())0 OT Size:
114-1 Serial #: k' r 41¢
Location of Device: Served what System:
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Install Yr.: • Rebuild Date:
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Test Yr. Check Valve #1 Check Valve #2 Differential Pressure Relief
1 (to 3 4 Leaked() Closed Leaked() Closed ( ) Did Not Open ( )
Overhauled ( )
Install () Pressure : Pressure : Opened At: _
R cleaned I cleaned . Cleaned
E Replaced Replaced Replaced
epF
Poppet Poppet
P Spring Spring Spring
A O Ring O Ring O Ring
Rubber Seat Rubber Seat Rubber Seat
I
Other Repairs Other Repairs Other Repairs
R
s
Certification • . .
I hereby certify the foregoing data to be correct and that the device tested is functioning
Within the limits of the standards
Signed: Dated:
COLE FORD Certification Al 066455 -PM j GARY FORD Certification # 056476 —PM 1 ALAN FARR Certification if 066481 BF
Metro Testing/ Metro Meckan>cai Coasaltaats, LLC 31222 Cedar Creek Rd, Hiacldey, MN 53037 612 - 221-5188
Plumbing Bond License: PC646918 Mechanical Band Certificate ID: 5054 -MB
This report is for the purposes of recording only; Owner is responsible for safe operation 1
and upkeep of scheduled maintenance.
IN
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