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Feb 26 07 06: 23a Mar� Borns Cell#6121 685- f9521 937-9165 P• � <br /> REDUCED PRESSUR.E BACI�FLOW PREVENT�R TES'1� RI:;PORT <br /> AN� i ESTAB"LE DOC?BLE. CHLC1<S <br /> I\1/�`1f/.t Y'Y� ��� �° ���� Contaci Persor,iTele '_` �-�-� rd )1�--- <br /> Service Name: � <br /> Adcress: � � d �� V�s'�^ �U�° City: �✓61'LD State: �?�P��y� <br /> Device Locatior: �Z 7/.t Yt�YI e Serve�.v ha t systerr: <br /> Account Number: ' Seri2( Number. 55 <br /> r� <br /> �ype. Make: I/II d �tedei:C� S�ze: <br /> install Dace: Air Gao Install2'tion C�ate <br /> ftebuild Date: Q� Test t7a;e: U ���{-�/ <br /> Annual <br /> Chec�`✓alve �1 Check Vaive .#2 ��ifferential Pressure Rzlief`Jaive <br /> Report Oper.ed at V �sid recuced pressure. <br /> Pressure �.a Pressure � 1 • ' <br /> Did not open <br /> Cleaned Cleaned ��1e2��:ci <br /> Replaced R�placec Replacec <br /> R Disc Disc �isc, Upper <br /> E Spring �pr��9 _ C�isc. Low�r <br /> P Guide Guide S•,:r�n9 : <br /> �`, Pin Re:ai�.er _ 'in Reiainer �iaphragm, �ar,r,e <br /> I Hinge Pin h:nge Pin Lo�^;cr <br /> rt <br /> Sea; Seat �_Ic,per <br /> Ciapnraom Jisphragm Dizphr�gm, Smail <br /> y Other, descri�A viher,describe _` : ��,v�r <br /> _ U.�per <br /> �ed': <br /> . ���r�gr <br /> �-�pPer <br /> 5oacer, t_o�ver <br /> •�iher, �escribe <br /> ��Sign and date 7ag <br /> The above is certified correct. SiSned � d`- �a;�Tes;e�:�' p��-Q� <br /> Tes�ed by (Print Name) �l�j�-�- L�O11r5 C7Y1 _ Certif;ca�ion Number��T <br /> Corporate Mechanical, Inc. <br /> 5114 I�il[sboro Avenue North <br /> ��ew�Hope, MT �5428 <br /> Phone (763)533-3070 <br /> Fax (7G3)533-�464 <br />