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HomeMy WebLinkAboutBackflow Preventer Test 2/24/2016 REDUCED PRESSURE BACKFLOW PREVENTER TEST REPORT AND TESTABLE DOUBLE CHECKS wag-5307i Service Name: J •5. Stiff `I-Z-1 Contract Person/Tele: Y-e �� 7 Address: IS%3© FR+atiEa-11v -net.5 , City: 'O'g- State:vwtl Zip: SS3-1-"L Device Location: uPPill2 I...v..11- r'^ Serve what system: ac>il)u Account# Serial# 2-13 Type: Install Date: Make: P+PP1' Model: Size: 31-4" Air Gap Installation Date: NEW/OVERHAULED ❑ Test Year 1 ❑ I Test Year 2 0 Test Year 3 g Test Year 4 ❑ Rebuild Date: Test Date: ox •z'-t• Annual Check Valve#1 Check Valve#2 Differential Pressure Relief Valve Report Pressure io•" Pressure c+-06.mo Opened at 2•S psid reduced pressure .Did not open Repairs: N� • ( .V)Sign and date Tag The above is certified correct. Signed Date tested 0-1 Z`t' Tested by(Print Name) �e•-•.) 0\.5 Certification Number o'-i—to-7-•-‘8-e CORPORATE MECHANIC PO TE MECHANICAL • 5114 Hillsboro Avenue North New Hope, MN 55428 Phone:(763) 533-3070 Fax (763)533-3464 •