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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 Di erential Pressure Relief
1 2 3 4 Leaked ( ) Closed Leaked
( ) Closed ( Did . Open( )
Overhauled()
Install ( ) Pressure : 2.O Pressure : 1.5 Opened •. :
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 Se,
I
Other Repairs Other Repairs Other, ' epairs
R
S
Certification # 2 Shutoff Valve:
I hereby certify the foregoing data to be correct and that the device tested is Pass
functioning within th- limits of the standards. Fail •
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Signature: ' r
Date• IC/HIV Assembly Final Test
Performance:
COLE FORD BF066445 I GARY FORD BF058476 I ALAN FARR BF066481 )<-1
Metro Plumbing Metro Testing,LLC 9112 Davenport Street NE,Blaine,55449 612-221-5888 PassPlumbing Bond License:PC646918 Mechanical Bond Certificate ID: 5054-MB Fail n
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 II' ferential Pressure Relief
1 2 3 4 Leaked ( ) Closed() Leaked ( ) Closed) Did of Open( )
Overhauled
Install ( )
Pressure : 2• o Pressure : 2 Opene' At:
R Cleaned Cleaned Cleaned
E Replaced Replaced Replaced
Poppet p
pP Poppet Poppet
P
Spring Spring Spring
A 0 Ring 0 Ring 0 Ring
I Rubber Seat Rubber Seat Rubber Seat
Other Repairs Other Repairs Other Rep:irs
R
S
Certification / # 2 Shutoff Valve:
I hereby certify the foregoing data to be correct and that the device tested is Pass ,5
functioning within the hill' of the standards. Fail ❑
Signature:
Date: V40\141\t,' Assembly Final Test
COLE FORD BF066445 I GARY FORD BF058476 I ALAN FARR BF066481 Performance:
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
Faitn
This report is for the purposes of recording only;Owner is responsible for safe operation and upkeep of scheduled maintenance.
E TR 0 , „L.-2; .
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 (Xc Leaked Did Not
Overhauled ( ) ( ) Closed Open( )
Install ( )
Pressure : _ Pressure : 'is" Opened At: Z .17
R Cleaned Cleaned
ReplacedCleaned
lReplaced p Replaced
P Poppet Poppet Poppet
Spring Spring Spring
A 0 Ring 0 Ring 0 Ring
I Rubber Seat Rubber Seat Rubber Seat
R Other Repairs Other Repairs Other Repairs
S
Certification - _ --i
# 2 Shutoff Valve:
I hereby certify the foregoing data to be correct and that the device tested is
functioning within the imits • the standards. Pass X
7 Fail n
Signature:
L.
Date: to l Lgi(Y AssemblyFinal Test
st
COLE FORD BF066445 i GARY FORD BF058476 1 ALAN FARR BF066481 Performance:
Metro Plumbing 1 Metro Testing,LLC 9112 Davenport Street NE,Blaine,55449 612-221-5888 I Pass
Plumbing Bond License:PC646918 Mechanical Bond Certificate ID: 5054-MB
Fail 7
This report is for the purposes of recording only;Owner is responsible for safe operation and upkeep of scheduled maintenance.