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Home My WebLink AboutAnnual RPZ 2013 • G R Mechanical, Inc. 1401 Ironwood Circle #500 Annual RPZ/Backflow Test _ .ogers, MN 55374 763 -428 -2663 Fax: 763 -428 -7656 Date: //.3 Customer: 1C, Site Address: ` � .-P 4(70 Pa /'4 Ai ta)(tf Alv 36= Contractor: G R Mechanical, Inc. Master License #I PM061337 Address: 12401 Ironwood Circle ; Phone: 763 -428 -2663 Rogers, MN 55374 _ Fax: 763 -428 -7656 Location of Device: 401' 4(1 Device Serves: f o `ice- f ) - Make: fth/p(( Model: 97 — (L Size: 3/ Serial #: LJ7 3 -% Check Check Pres. Dif. Pres Dif Valve #1 Valve #2 Across #1 When Relief Strainer Test before Leaked { } Leaked Repairs Closed { } Closed { } P PSI None { } Clnd { } 1 . final Test Closed Closed PSI t 0 PSIS, 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 Describe Repaires .b j . ct.r 2 .., / I hereby certify that this date is accurate and reflects the proper operation and maintenance of the assembley. il Testers Name (Print i -q a 6' Oen esters Si Certification # b Signature: � (7 l Date: J� �� f/ .