HomeMy WebLinkAboutBackflow Preventer Test
4715.2260
Annual Testing
of R.II.Z. Valves
4.DDRI.SS
BACKFLOW PREVENTER TEST REPORT
PI.-.
ZIP
TEST
BEFO tE
REPAIR
DESC ~IBE
REPAIR
FINA~
TEsT
MATERIALS
UsED
CERTI F I CATION :
I hereby certify the foregoing data to be correct and that the tested device is
functioning within the limits of the standards.
FIRM IN.;ME~bs-r~ ADDRESS-,':?/')~f/lUt.o1dl five tt/-+Io~//JI~
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BVj.-.,rdt/ ~;:(rl'-- TEsTER'S CERTIFICATION No.-.:iir-t" TEL. NO.61:>- x>J-
Lf781
OWNEr.
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G/~lfl0nA. 0~
HAKE AND HODEL Of DEVICE siZE
W~ q7~'V L.
LOCA:IOfi OF DEVICE:
CHECK VALVE II CHECK VALVE '2
LEAKED \ l
CLOSED tX!
LEAKED ( )
CLOSED ~
LEAKED ( )
CLOSED ( )
LEAKED ( )
~
DAlE
TELEPHOfiE NO.
DATE: r: J t
. U-~
SERIAL NO./ 6
,0 ~O'-I
a'~
PRES. Olf. PRES. OIF. STRAINER
ACROSS 11 WHEN RELIEF
CHECK OPENS
psi psi NOllE ~ O()
fl. if CLIlO )
9:71
----ps i
psi
REMARKS
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