Loading...
HomeMy WebLinkAboutRPZ Report 7/6/2009 OPERAT1DNS & REGULATORY SERVICES INSPECnONS.DMSION 250 South ,/. Strut - Room 300 Minneapolis, UN 55415-1318 www.cl.mlnn..polls.mn.uaJInapec:tlons BACKFLOW PREVENTOR (RPZ) TEST REPORT . .I,€to~ ~e MA/P3372.- /YI#r r13;'E/1/f111A! COtfrACT PHONE: CJ5J -J.3<r -6'13> FLOOR .: --- ROO".:~ SERVES WHAT SYSTEM: XU (' \ MAKe: w~, 'Zrr~ MODEL,#: , '7SXL StzE: 2/1 SERIAL t: 3f;;? Y2r' INSTALL DATE (MONTHlDAYIYEAR): OVERHAUL DATE (MONTHIDAYIYEAR):~ TEST DATE (MOtmuDAY/YEAR): 7-b:- 0'1 . 7-&'-0,/ f1 CHECK VALVE PSIIOIFF RELIEF PSI/DIFF 12 CHeCK VALVE TEST BEFORe REPAIRS l.J,o ~tD1t;"l1 FfNAL TEST I DESCR_ _~R IF ANY, ", "~'. .- ,~. TEST DONE BY (PLEASE PRINT FtRST & LAST NAME): CERTlFlCAT10H NUMBER: t'li:bU- CtTY: ZIP: fir . ATTACH COMPLETED TEST REPORT TO PLUMBING/GASFmrNGlRPZ PERMIT APPLICATION AND SUBM" WITH FEE