HomeMy WebLinkAboutBackflow Preventer Test Report 12/11/2014 REDUCED PRESSURE BACKFLOW PREVENTER TEST REPORT
AND TESTABLE DOUBLE CHECKS
Contract Person Tele: �,ur gicjim�// 9rz Z� b0
Service Name: :,, '/
Address: ,t r .AIMIREP City: j gm. f/� State) /1N Zip: 0772
MOWDevice Location: W i Serve what system: gorW
Account# Serial# fi zlj
Type: gi9Z J ��II
Install Date: Make: o o Model: 70, In
Size:
3u
Air Gap Installation Date:
NEW/OVERHAULED 0 Test Year 1 0 Test Year 2 X Test Year 3 0 Test Year 4 0
Rebuild Date: Test Date: ,12 4/1
111
Annual Check Valve#1 Check Valve#2/ Differential Pressure Relief Valve
(,
Report Pressure .a Pressure �.`� Opened at • sid reduced pressure
• r Did not open
1
Repairs:
Sign and date Ta
( ) 9 9
. The above is certified correct. Signed Date testedM/�'
Tested by(Print Name) 7 i �y,/71 Certification Number d27,c/
ORPOTE .
�
/MECHANICAL
5114 Hillsboro Avenue North
New Hope, MN 55428
Phone:(763) 533-3070
Fax (763)533-3464
•
•
i