HomeMy WebLinkAboutRPZ Test 10/18/2007
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Metro Testing
31222 Cedar Creek Road
Hinckley, MN 55037
612-221-5888
Backflow Preventer Test Report
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Contact Person! Tel.
Date:
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Owner:
Address:
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Make: "
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Location of Device:
City:
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Serves what System:
Zip:
Model: q 7 'i" 'f L
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Size:
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Serial: '"
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Test Year Cbel:k Valve #1 Check Valve #2 Differential Pres. Relief
\,.-.'''It;....\ Leaked( ) Leaked( ) Did Not Open
~ tJQ r Closed ~ C/;.fc Closed t>) CA.O Opened At ~. (-I
Pressure Pressure
_..-
- Cleaned Cleaned Cleaned
- -
R _ Replaced _ Replaced Replaced
_ Poppet _ Poppet _ Diaphragm
E _ Spring _ Spring _ Spring
P ORin _ 0 Ring ORin
- g - g
A - Rubber Seat - Rubber Seat - Rubber seat
I Other Repairs Other Repairs Other Repairs
R
S
Certification
I hereby certify the foregoing data to be correct and that the device tested is functioning
Within the limits of tbe standards
Firm Name: Metro Testine: 31222 Cedar Creek Rd. Hincldev. MN 55037
Tested By: Gary Ford CertifICation # 1649T OR Cole Ford Certification ## 2243T
This report is for the purposesIRecording only; Owner is responsible for safe operation
And upkeep of scheduled maintenance.
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