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Feb 26 07 0�: 23a Mary Horns Cell#6121 685- (9521 937-9165 P• � <br /> REDUCED PRESSURE BACICFLOW PRE��'ENTLR TES'1� RLPORT <br /> AN� iESTABLE DOUBLE. CI-ILCKS <br /> t ' r�f1.�11 <br /> Service Name: �J A 1 a��u�P �� �'�P �.��'sd:�. Contaci Psrsor,iTele -� <br /> Adcress: � � �� �.i V� u�as ►1P_ City: ��'O`RO State: L�Y11r?�P� ��1�t� <br /> Device Locatior: /"l PZZan ►I�t� Serve �.vhat systerr: ��'�SS �tYe �� <br /> Account Number. Ser2f Number: � � '�5 � <br /> n,�,p�n 4 <br /> Type: Make: viedel:�ll�.o� S�ze: <br /> Install D2te: Air Gao Install2iion Date <br /> Rebuild Date: �J� Test Da;e: —�� <br /> �,nnuai <br /> Chec;� Valve �1 Check Valve #2 ��ifferential Pressure R21ief`Jaive <br /> Report 3.� osid recuced pressure. <br /> Pressure �� Pressure •� Oper.ed at . <br /> Did no� open <br /> �leaned Cleaned '��2a��ci <br /> Replaced Replacec F�eplacec <br /> R Disc Disc ��sc; Upper <br /> E Spring �pr��9 _ Disc. Lo�ver <br /> P Guide Guid� S;.'nng <br /> /=. Pin Retair.er ?in Reiainer �iaphragrl, I_�rg� <br /> I Hinge Pin h`n5e Pin ._ Lo�^:cr : <br /> � Sez: S�at �_�cper <br /> ; <br /> C�iapnraom Ji�ptiragm ��i�phragm, Smail <br /> y Other, descrite Gihe:,describe __ _�,,��� <br /> _ U�per <br /> �eo,: <br /> L����er <br /> UPper <br /> 5aacer, I_o�•�er <br /> Gther, desc�ibe <br /> L_�!/ Sign and date 7ag <br /> i he above is certified correct. SiSred � . Ct,,GDv�- �a:�Tes;e�: O 'a l�—Q� <br /> Tes[ed by {Print Name) �/��r� �Q i�,S n�. Certif;ca�ion NumberQ7 7a�� <br /> Corporate Mechan.ical, Inc. <br /> 5] ]4 IIillsboro Avenue North <br /> �etiv Hope, NfN �5428 <br /> Phone (763)533-3070 <br /> Fax (763)533-3464 <br />