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HomeMy WebLinkAboutRPZ Test 2/1/2011 �� � C/ � ( G R Mechanical, Inc. Annual RPLBackflow Test 12401 Ironwood Circle #500 Rogers, MN 55374 763-428-2663 Fax: 763-428-7656 Date: a I_ I I Customer: L ' p � � Si#e Address: .� (' ' i Gc� � � : j � � ��/� Contractor: G R Mechanical, Inc. Master License �f PM061337 Address: 12401 Ironwood Gircle � Phone: 763-428-2663 Rogers, MN 55374 FBX: 783-428-7656 Loca#ion of Device: �8 �� ,`( � � Device Serves• ��, � �� .�� � Make: Y�l� I�� r� 5 Modei: — l L Size: 3 Serial #• �l �___� 7� . Check Check Pres. Dif. Pres Dif Valve #1 Valve #2 Across #1 When Relief Strainer Test before Leaked {} Leaked {} PSI PSI None {} Repairs Closed { } Closed { } Clnd { } Final Test Closed � Closed �+ PSI "$� a PSI 3� Cleaned only: { } Cleaned Only: { } Replaced: Replaced: Rubber kit { } Rubber kit { } CV Assembly { } CV Assembly { } O-rings { } O-rings { } Seat { } Seat { } Spring { } Spring t } Stem/Guide { } Stem/Guide { } Retainer { } Retainer { } Lock nuts { } Lock nuts { } Other Other Describe Repaires Remarks: _ I hereby certify that this date is accurate and reflects the proper operation and maintenance of the assembley. Testers Name (Print) l��" ,,i�-et�yG 1'1 Certification # DG � r 9�g� Testers Signature: Date: a- - 1 — I(