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Reduced Pressure Zone Backflow Preventer Valve & Double Check (DC) Assembly Valve
Rebuild & Test Report
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Test Yr. Check Valve#1 Check Valve#2 Differential Pressure Relief
1 3 4 Leaked ( ) Closed (X) Leaked ( ) Closed ') Did Not Open( )
Overhauled( ) 4Install( 0
Pressure : q 2 Pressure : O Opened At:
R Cleaned Cleaned Cleaned
Replaced Replaced Replaced
E Poppet Poppet Poppet
P Spring Spring Spring
A 0 Ring 0 Ring 0 Ring
Rubber Seat Rubber Seat Rubber Seat
I Other Repairs Other Repairs Other Repairs
R
S
Certification #2 Shutoff Valve:
I hereby certify the fe egoing data to be correct and that the device tested is Pass X functioning within trt- 1 v', s of the standards. Fail ❑
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Signature:
Assembly Final Test
Date: 2 l Performance:
COLE FORD F066445 I GARY FORD BF058476 1 ALAN FARR BF066481
Metro Plumbing I Metro Testing,LLC 9112 Davenport Street NE,Blaine,55449 612-221-5888 Pass
❑
Plumbing Bond License:PC646918 Mechanical Bond Certificate ID:5054-MB
This report is for the purposes of recording only;Owner is responsible for safe operation and upkeep of scheduled maintenance.
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Reduced Pressure Zone Backflow Preventer Valve & Double Check (DC) Assembly Valve
Rebuild & Test Report
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'Tit Yr. Check Valve#1 Check Valve#2 Differential Pressure Relief
1 3 4 Leaked ( ) Closed (X1 Leaked ( ) Closed Q Did Not Open( )
Ovuled( )
Install ( ) Pressure : 9,a q Pressure : c6` 1 Opened At: 3,o
R Cleaned Cleaned Cleaned
E Replaced Replaced Replaced
P Poppet Poppet Poppet
Spring Spring Spring
A 0 Ring 0 Ring 0 Ring
Rubber Seat Rubber Seat Rubber Seat
I
Other Repairs Other Repairs Other Repairs
R
S
Certification # 2 Shutoff Valve:
I hereby certify the foregoing data to be correct and that the device tested is Pass'r
functioning within the limits of the standards. Fail ❑
Signature: , V1-
Date: 10I2ti it Assembly Final Test
Performance:
COLE FORD BF066445 I GARY FORD BF058476 I ALAN FARR BF066481
Metro Plumbing I Metro Testing,LLC 9112 Davenport Street NE,Blaine,55449 612-221-5888 Pass
Plumbing Bond License:PC646918 Mechanical Bond Certificate ID:5054-MB Fail
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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Reduced Pressure Zone Backflow Preventer Valve & Double Check (DC) Assembly Valve
Rebuild & Test Report
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Test Yr. Check Valve#1 Check Valve#2 Differential Pressure Relief
1 2 3 4 Leaked ( ) Closed (> Leaked ( ) Closed (> Did Not Open( )
Overhauled( )
Install ( ) Pressure : 1,3 Pressure : 7, Opened At: Yr rl
R Cleaned Cleaned Cleaned
E Replaced Replaced Replaced
P Poppet Poppet Poppet
Spring Spring Spring
A 0 Ring 0 Ring 0 Ring
I Rubber Seat Rubber Seat Rubber Seat
Other Repairs Other Repairs Other Repairs
R
S
Certification # 2 Shutoff Valve:
I hereby certify the foregoing data to be correct and that the device tested is Pass xj
functioning within e limits of the standards. Fail ❑
li
Signature: Ai'
Date: I�f 2�(�NI
Final Test
Performance:
COLE FORD BF066445 1 GARY FORD BF058476 I ALAN FARR BF066481
Metro Plumbing I Metro Testing,LLC 9112 Davenport Street NE,Blaine,55449 612-221-5888 Pass
Plumbing Bond License:PC646918 Mechanical Bond Certificate ID:5054-MB Fail
This report is for the purposes of recording only;Owner is responsible for safe operation and upkeep of scheduled maintenance.