HomeMy WebLinkAbout RPZ Test Boilers 8.14.13 FROh! (THU> 8 16 2013 1 1 : 3 1 . / 6 T . 1 1 : 29 /No. 8001737484 P n®
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M TE!TING�
MECHANICAL
Reduced Press ure Zone Backflow Preventer Valve & Pressure Breaker Valve
Rebuild & Test Report
Business: ContactPerson/Tel.: . Date:
Addreea: ti
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Make: ��/0f Model: Size: gy Size' ¢,. Serial if: /M 9 e/ .
Location of Device: Served what System:
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Install Yr.: • Rebuild Date: y
Test Yr. Check Valve #1 Check Valve #2 Differential Pressure Relief
1 2 3 () Leaked() Closed ( ) - Leaked() Closed ( ) Did Not Open ( )
Overhauled () �+
Install () Pressure : -1 -'D� ¢
Pressure : C if... Opened At: 4
R Cleaned Cleaned Cleaned
1 Replaced Replaced Replaced
Poppet 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 . e correct and that the device tested is functioning
Within the limits of the standards t ,� ) !3
Signed: V 1b Dated: !
COLE FORD Certification 0 066455 -PM 1 GARY FORD Certification g 053416 —PM 1 ALAN FARR Certification 0 066431 BF
Metro Testing/ Metro Mechanical Conauitanta, LLC 31222 Cedar Creek Rd, Hiicidey, MN 55037 612- 221.5333
Plumbing Bond Liceme PC646918 Mechanical Bad Certificate ID: 5054 -MB
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This report is for the purposes of recording onlyi Owner is responsible for safe operation
I and upkeep of scheduled maintenance.
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