HomeMy WebLinkAboutRPX Test 2/7/2007
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G R Mechanical, Inc.
12401 Ironwood Circle #500
Rogers, MN 55374
763-428-2663 Fax 763-428-7656
Annual RPZ/Backflow
Test
Date: d-
Customer:
Site Address:
A-vc ~
Contractor:
Address:
G R Mechanical. Inc. !\1aster License #: PM005081
12401 Ironwood Circle #500 Phone: 763-428-2663
Rogers. 1viN 55374 Fax: 763-428-7656
Location of Device:
Device Serves:
~t'~
, 11'
Make: i/Vl r 1\.. ()~
Model: 1115'f..L Size: 1 Seria1#: lj7370b
Test before
Repairs
Check
Valve #1
Leaked { }
Closed {
Check
Valve #2
leaked { }
Closed{ }
Pres Dif
Across # 1
Pres. Dif
Wnen Relief Strainer
None { }
PSI Clnd { }
PSI
Final Test
Closed P(} Closed M
PSI '0.-0
PSI :J-, II
Cleaned only: Cleaned Only:
Replaced: Replaced:
Rubber kit Rubber kit
CV Assembly CV Assembly
O-rings O-rings
Seat Seat
Spring Spring
Stem/guide Stem/Guide
Retainer Retainer
Lock nuts Lock nuts
Other Other
Remarks: A-Q.,Dvw'lt ~))-)03
I herby certify u~at this date is accurate and reflects the proper operation and maintenance
of the assembly.
Testers Name (Print) ~jj/l
Testers Signam-:-e: __ ~ _
COIL #: ~{~T
Date: I 7