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BACKFLOW PREVENTER TEST REPORT
BOILER SERVICES, INC.
10327 Flanders Street NE
Blaine, MN 55449-5711
763-784-8178
I Job #23577
Site Address: 16817 DULUTH AVE. SE. PRIOR LAKE.
Zip:
Occupant: WELLS FARGO PROPERTIES Phone: 612- T estDate:417/06
667-2984
Device Make and Model: WATTS 009QT Size: 1/2" Serial #:210214
Device Location: L T MECHANICAL ROOM
Device Serves What System: BOILER FILL
Cbeck Valve #1 Cbeck Valve #2 Press. Dif. Press. Dif. Strainer
Across #1 Wben Relief
Cbeck
Test Before Leaked [ ] Leaked [ ] 9.8 WOULD NOT None [xl
Repairs Closed [x] Closed [x] OPEN
Final Test Closed [ xl Closed [x] 9.8 4.2
Comments: REPLACED RELIEF ASSEMBL Y. OVERHAUL 2008
CERTIFICATION - I hereby certify the foregoing data to be correct and that the tested
device is functioning within the limits of the standards.
BY~?l(~
DON PYLES Tester Certification # 00505T
Phone # 763-784-8178
BACKFLOW PREVENTER TEST REPORT
BOILER SERVICES, INc.
10327 Flanders Street NE
Blaine, MN 55449-5711
763-784-8178
I Job #23577
Site Address: 16817 DULUTH AVE. SE. PRIOR LAKE.
Zip:
Occupant: WELLS FARGO PROPERTIES Phone: 612- TestDate:4/7/06
667-2984
Device Make and Model: WATTS 009QT Size: 1/2" Serial #:210203
Device Location: L T MECHANICAL ROOM
Device Serves What System: OLD SYSTEM
Check Valve #1 Check Valve #2 Press. Die. Press. Die. Strainer
Across #1 When Relief
Check
Test Before Leaked [ ] Leaked [ ] None []
Repairs Closed [] Closed []
Final Test Closed [] Closed []
Comments: THIS VALVE IS NO LONGER IN SERVICE
CERTIFICATION - I hereby certify the foregoing data to be correct and that the tested
device is functioning within the limits of the standards,
By~ ~t-
DON PYL S Tester Certification # 00505T Phone # 763-784-8178