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Reduced Pressure Zone Baddlow Preventer Valve & Pressure Braurer Valve
Rebuild & Test Report
Ceded
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Localism Served wire Systeme
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Wad Yr.: Reber Dale
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Test Yr. Check Valve #1 Check Valve #2 Diffecoolial Pressure
T ( } Leaked() Closed (0 ) Leaked() Closed ( DM Nat ( )
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Pressure : /G3•
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ru e: b open a • r
R Cleaned atoned cleaned
P Poppet Poppet
Bring Sizing A o Ring O Ring • p Ri '
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Rubber Seat Rubber Seat Rubber Batt
R Other Repairs Other Repairs Other Repairs
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Certification
I hereby certify Within the limits,of the standards 6
the foregoing data to be oorreat and that the device tested is functioning
Signed:. Dated: dfiaget
COLS F(*D a 11K4SSMI 1 OARYFORD Cailaeaaea o id$474 -rM 1 ALAN PAU CeNMeaaaa 0 won -
Me re Ted* Metre Medmaisel 4Aartme, LLC 31333 Cedar reek IA l taelaey,MN 11537 6M -Ml4IN
1'hEiie3 Liam PC6469111 Meoiwioelaaaa Ceedloele D: S.54-/M
This report is for the purposes of r p only; Owner is respctudble for afo operation
and upkeep of scheduled mainhenanoe,
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