HomeMy WebLinkAboutBackflow Preventer Test
4715.2260
Annual Testing
of R.P.Z. Valves
BACKFLOW PREVENTER TEST REPORT
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TELEPHONE NO.
DATE: r- ./
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MA E AND MODEL OF DEVI~ A
La ATION OF OEVICE:
a SIZE ",
-, P\ '201
~'k h=CKt
SERIAL NO.
~
CHECK VALVE 11 CHECK VALVE 12 PRES. DIF. PRES. OIF. STRAINER
ACROSS n WIlEN RELI EF
CHECK OPENS
LEAKED LEAKED psi psi NONE
CLOSED CLOSED { cum
( ');..
.
LEAKED
CLOSED ( )
LEAKED
psi
---ys i
C RTIFICATlON:
I hereby certify the foregoing data to be correct and that the tested device is
functioning within the limits of the standards.
NAME ~.bS1"ma,^ ~b/'~ ADDRESS 31'S6-7 flJvt40ici-l flvt' kf"I?~/J1/W
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't..IiIn I'V TESTER'S CERTlFlCATlQt~ NO. tflf'-;- TEL. ND,v,/z- ?OI-
Lf781
REMARKS
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