HomeMy WebLinkAboutRPZ Test 9.4.13 FROM <THU) 9 12 2013 9: 25 /ST. 9 : 29,No.8001737537 P D
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MECHA i•
Reduced Pressure Zone Backflow Preventer Valve & Pressure Breaker Valve
Rebuild & Test Report
Business: Contact Person /Tel.: Date:
I V �n i 1 �S� - �3o -grad :
Address: I L� o o b U L rf� S E � Yr c (aK� � �'
Make: Model: L Size: 7 2. w Serial #: J` Q GJ
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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 Presgurc Relief
Closed Did Not Open ()
2 3 4 ;Leaked() Closed �'" Leaked() �
Insinll {) Pressure : �I . P ressure : 5 C O pened At: _
• R cleaned Cleaned Cleaned Replaced Replaced Replaced {
E P t P oppe t Poppet
P Spring Spring Spring
A O Rung O Ring Rubber ingg 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 .
tandards '
Signed: A i
lls Dated: y
COLE FORD Certification • 066455 -PM ( GARY FORD Certification • 056476 PM i ALAN FARR Certification 4 066411 BF
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Metro Testing! Metro Mechanical Consultants, LLC 31222 Cedar Creek Rd, Hinckley, MN 55037 612 - 221. 1111
Phunbing Bond License: PC646918 Mechanical Baud 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.
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