HomeMy WebLinkAboutRPZ Test Penthouse Boiler Room removed a * •
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Reduced Pressure Zone Backflow Preventer Valve & Pressure Breaker Valve
Rebuild & Test Report
Business: ` -
Contact PersonfTel.: Date:
ItiCACier, S m iddfr DWI .vi WI Del WO 457- 2'249 -6O 4- .
Address: Cis' . 5 - 53 - ) 2-
15G 7 519 C1 �rp Cc -
Model: t' ,� i Siie: ?j¢ I Serist #: 4 2 $ 1SDc, .
Maker „ `Q�'f'� � 44'' 2/
u Served what System: Location of Device: .p n `-� / „ r
T b '�' *, � Mo e Ro tt a Rebuild Date;
install Yr.: � I g'fX)il
Check Valve #2 Differential Pressure Relief
1 1% Xr. Check V - e #1 Leaked(} Clo �, � � ( ) Did open
1 f) 3 4 Leaked() dosed ( )
0 - • ( ) Opened At
install () Pressure : Pressure :
R Cleaned Clean -, cleaned
R eplaced Rep "' Replaced
E
Poppet , . Poppet
r Spring : 1 4 g spring
A o Ring p ' I. Ring
Rubber Seat Rubb Rubber Seat
I Other Repairs Other
Other Repairs
R
s
Certification •
1 hereby certify the f• -going data to be correct and that the device tasted is functioning
Within the limits o ; , e standards Dated
Signed
COLE FORD Certification 5O66455 ( GARY FORD Cortlflcatlan 5 055476 -PM 1 ALAN FARR Certification 5 0664111 BF
Metro Tostine Metro Maebaaleal Consultants, LLC 31222 Cedar Creek Rd, hey, MN 55037 611 -221
P 'Bond License PC646918 Mechanical Bond Certificate ID; 5054 -MB
1 This report is for the purposes of recording only; Owner is responsible for safe operation
and upkeep of scheduled maintenance.
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