Laserfiche WebLink
� MAY. 15. 2006�.,12:37P�M�� LBP. MECHANICAL N0, 811 P, 5 <br /> OI�RATIONS ae REGULATORY SERVICES <br /> INSPFCT10N3 DMSION <br /> 25o south 4'"Street--Room 30� <br /> Minnaapblls,MN 5541511316 <br /> � www ci.minn�polls.mauslinspeWons , <br /> . BACKFLOW PREVENTOR (i2PZ) TEST REP�RT <br /> JOB ADDRESS: ��'OO <br /> OWNERIiOCCUPANT/CONTACTPERSON: � • NTACTPHONE: <br /> DEVICE LOCATION: �� FLOOR� ��,,,e ROOIYI� <br /> SERVES WHAT SYSTEM: � � �`D�� �`-�� <br /> MAKE: �,JA„�`,S' MOpEL�: �O � s�� �� SERIA��:� /S� <br /> INSTALL DAYE(AIONTWDAYIYEAR� OVERHAUL qATE(MONTH►DAYIYFAR): TEST D/►7'E(MONTHNAYIYEAR): <br /> 5` !/ Q�' <br /> ih CHEdC VIALH� RF.�IEF �R'1 CHECK VAI.VE <br /> p��p� PSUDIFR <br /> �sT B�o��aRs �a.� �L,t,� �o� � !• �L�S,O <br /> FINAL YEST . <br /> pESCRIBE REPAIR IF ANY: . <br /> TEgT pONE 61r(PLEASE PR1NT FlRST 8 LAST NAME)� <br /> CEKpFICA710N NUIMHER� <br /> (.Z� !� � /��� /1- �'9— 0.��13 T <br /> COMPANY NAME: CON7'RACTOR UCENSE� <br /> COMPANY ADDRESS: / N � COMP PHON�� Z :3� SIS <br /> C�: �A� ap: CCNTAG?P�RSOI�uPHONF�k <br /> ATTACH COMPLETED 7'EST REPORT YO PUNIABINGIGASFITTINGIRPZ PERMIT APPLJCATION AND <br /> SUBMIT WITH�EE <br />