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3770 Shoreline Drive - 17-117-23-34-0086
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backflow preventer tests
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Last modified
8/22/2023 3:38:53 PM
Creation date
12/18/2018 11:44:02 AM
Metadata
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Template:
x Address Old
House Number
3770
Street Name
Shoreline
Street Type
Drive
Address
3770 Shoreline Drive
Document Type
Misc
PIN
1711723340086
Supplemental fields
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' ` 3?7o Sh���..we ,Q I�� <br /> Feb 26 07 06: 23a Mar� Borns Ceil#612) 685- (952) 937-9165 P• � <br /> REDUCED PRESSUR.E BACICFLOW PRE��'ENTLR TES'1� RLPORT <br /> AN� i ESTA$"LE Dt`�UBLE. CI�LC1<S <br /> Service Name: <br /> ` Cont�ct Persor,iTele w e ^ <br /> ` City: ,�,�f'B 1'1 D �tate: ��► _ZiP� _ 3�3 <br /> Adcress: �(�! � <br /> Device Loc�tior: � ,'�� G�►1�,.]rt +� Serve�.vhat system: ���f�P '�Y U G�'4�� �� <br /> Fccount Number. Seri21 Number. � � ,� <br /> Type: Make: �viodel: �Q�.._ Size: <br /> Install Date: Air Gao Install2�ion Gate <br /> Rebuild Date: l � - / — �� Test Date: � ��� <br /> �,nrual <br /> Check Valve �1 Check V21ve #2 ��ifferential Pressure Ralief'Jaive <br /> Report Oper.ed at ��sid r2cuced prsssure. <br /> Pressure �� Pressure ��_ . <br /> Did �o[•�pen <br /> Cleaned Cleaned ��laaned <br /> Replaced Replacec ReplaCe� <br /> R Disc Disc �isc: UpF•er <br /> E Spring vp���9 _ G�isc, Low�r <br /> P Guide Guid� S•vrmg : <br /> .r=, Pin Re:ai�er ?in Retainer __ �iaphragm, �arr;e <br /> I tiinge Pin h�nge Pin ._ Lo�^;er <br /> rt <br /> Sez: Saat r_)c�per <br /> C�iapnragm Ji�phragm ��i�phr�gm, Smail <br /> y Other, describ? uthe�,describe _` _�;v�r <br /> ���pef . <br /> �.,a'. <br /> ���riBr <br /> Upper <br /> SDacer, I.o�•�er <br /> vTher, ��scribe <br /> �� Sian and date 7ag <br /> i he above is certified correct. SiSred ..� �a:�Tes;e�: O � <br /> Tes�ed by (Print Name) � � I�,P r� �L�Y_S Ul/� Cerlifica�ion Number(%��� <br /> Corporate Mechan.ical, Inc. <br /> 51 l4 IIiI[sboro Avenue North <br /> �ew-Hope, MI�° �5428 <br /> Phone (763)533-30i0 <br /> Fax (763)533-.i464 <br />
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