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RPZ Test Report 12/15/15
• s SSOCIATED • ., mechanical ontractors, , -, .,-,,-,:_,2 1257 Marschall Road, RO. Box 237 e Shakopee, MN 55379 Phone: 952/445-5100 Fax: 952/445-5119 • BACKFLOW PREVENTOR (RPZ) TEST REPORT . . . . . . . . JOB ADDRESS: 8 5••-• 1116,1" 4 ' ,,,) „e„, 7--. - ir r ' 44 OWNER/OCCUPANT/CONTACT PERSON: , - CONTACTMONE:5 ' - Ali . . DEVICE LOCATION: /h .. ,, mie. . FLOOR*: e_ ROOM#: MODEL;Y: Clinfiall IMIZMININI INSTALL DATE(MONTH/DAY/YEAFt): OVERHAUL DATE(MONTH/DAY/YEAR): TEST DATE(MONTH/DAY/YEAR): / - 7—/ --- . 2— "• 7 — si CHECK VALVE RELIEF #2 CHECK VALVE 111111111111 PSI/DIFF PSI/DIFF TEST BEFORE REPAIRS MEM MZIIIIIIIIIIIINIIIIIIIIIIIIIIIIIII DESCRIBE REPAIR IF ANY: . • TEST DONE BY(PLEASE PRINT FIRST&LAST NAME): CERTIFICATION NUMBER: .._... de)4'1' . .,,,/te.)-5 ....• 63Si/6. 1'4 1 COMPANY NAME:AS S°el at ed Mechanical Contrattors CONTRACTOR LICENSE N: Pri II u)-ti'1 li 1 952-445-5100 COMPANY ADDRESS:1257 Ma r s c ha 1 1 Rd PO Box 237 COMPANY PHONE#: CITY: Shakopee STATE: MN ZIP: 55379 CONTACT PERSOWPHONEt Kevin