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JUN, 5. 2001 11 : 33AN� LBP, MECHANICRL N0. 790 P, 3'0 <br /> _ __ � <br /> � . <br /> OP�RA'170N5&REGULATDRY S�RVICES <br /> INSPECT]OIVS DIVISION <br /> 250 South 4'�St►eet-Room 300 <br /> Minneapolis,MN 5541�1316 <br /> www.ci.minneapolis,mn.uslinspections <br /> BACKFLOW PREVENTOR (RPZ) TEST REPORT <br /> JOB ADDRESS: �r'�� ' <br /> J <br /> OWNERlOCCUPANTl��MaCT PERSON: �s� �,�y�� �N�rl r ONTACT PHONE: !.p'� ��T -9 <br /> DEVICE LOCA�7�N: �r����,(`� �� FLOOR#: ����/�i ROOM#: <br /> S�RYES WHAT SYSTEM: v � Q�Q � <br /> b1AKE: �f�LL/����5 MQOEL#: �`7.� x� SIZE: 2 �� SERIAL�: 3 7� ��.� <br /> �NSTAI.I.�ATE(MONTHIDAYIYEA�: OVERHAUL DATE(MONTHIDAY/Y�AR): TEST DATE(MONTH/pAY/YFAR)- <br /> S �/ �7 <br /> ?�� #1 CHECK VALVE R��I�F il�2 CHECK VA�v� <br /> PSI/DIFF P3UDI�F <br /> TEST BEFORE I2�PAIRS 7. � C,`�p ,', � 3� � ��S Q <br /> FINAL TEST • <br /> D�SCRIBE REPAIR IF�NY: i <br /> (J�u.prf� <br /> TEST DONE BY(PLEASE PR1NT F1RST&LAST NMAE): <br /> � , n S CERTIFICATION NUMBER: �c� �� l,� y <br /> !7�� � �' / <br /> COMPANY NAME� � � B .T L� L C CONTRACTOR LICENSE�: <br /> COMPANY ADDIZESS: 0 Y r COMPANY PHONE#: r6�. �r����S) <br /> C�7�f; STATE: I� ZfP: �S`I CONTAC7PERSOWPHdNE#: ��Z�3�g — lsZ- <br /> ATTACH COIVIIPL,ETED 7EST R�pORT TO PLUMBING/GASFITTING/RPZ PERMIT APPLICATION AND <br /> SUBMIT WITH F�� <br />