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Home My WebLink AboutAnnual RPZ Test 2014 . • . � �( G R Mechanicai, inc. 12401 Ironwood Circle #500 Annual RPZ/Backfiow Test Rogers, MN 55374 763-428-2663 Fax:763-428-7656 Date: � .- 3 � _ � � Customer: ��or -� Site Address: C � '� �Y (�..IL.e Contractor: G R Mechanical, Inc. Master Licertse � PM061337 J� 3 �� Address 12401 Ironwood Circle; Phone 763-428-2663 Rogers, MN 55374 FaX: 763-428-7656 Location of Device: y�/� �� Device Serves: a o M �• I�e.; S Make: � � �� IPAodel: � S� L. Size: 3�y �� Serial #: `� � 3 7�1[v Check Check Pres. Dif. Pres Dif Valve #1 Valve #2 Across #1 When Relief Strainer Testbefore Leaked { } Leaked Repairs Closed {} Closed {} PS � PS� None { Cind { } Final Test Closed � Closed {�-/ PS{ PSI Cleaned onl : � � � '�" 7 Y { } Cleaned Oniy: { } 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 Remarks: I hereby certify that this date is accurate and reflects the proper operation and maintenance of the assembley. Testers Name (Print �e � �� `��, (�L\ Certification # ��.- � Testers Signature: b b �� U ( 13 � l Date: __ j - � � - i �