Laserfiche WebLink
16-SEP-2008 12:44P FROM:LONG LAKE PUBLIC WKS 952 4762856 TO:9522494616 P.1 <br /> uair41Au14 WVY.L <br /> ROTO ROOTER PLUMBING SERVICES CO.: <br /> BACKFLOW PREVENTION (RPZ) TEST REPORT <br /> 14530 27th Avenue N. <br /> - Plymouth, MN $5447 <br /> 763-559-3522 <br /> Customer jdg:r Device Location -d - <br /> Sita Address es�i�/.#�ij�- ��• System Isolated &WW" ti r <br /> Clwstata .-, Q,If� ZA64�.� __ Install Date AJ 7 <br /> Contact Person A ` Z Overhaul Dale 9t <br /> Phone Number 67—fe7/— OW17 Test gale <br /> Type of Assembly: RPZ❑ DCV❑ _ , <br /> Make Model Sial Number Size <br /> New Replacement, If applicable: <br /> Make Madel Serial Number size <br /> CHFECK VALVE 01 RELIEF VALVE CHECK VALVE 62 CHECKVALVE92 <br /> BACK PRESSURL CONFIRMATION <br /> ❑ Leaked Opened at: .._ psi ❑ Leaked p Leaked <br /> ❑ Closed tight Did not open ❑ Closed tight ❑ Closed tight <br /> Dfte ytial`Ifri d ii ia' .. ❑ ' ....'�_.. .— _-OiRerentlal pressu�e--� _ �M'erentl0Vresas+re-'• -�-, •- <br /> psi psi psi <br /> ❑ Cleaned only [] Cleaned only [) Cleaned only <br /> Rept cad; Rd: Replaced: <br /> Rubber kIt rRubberldt Rubber kit <br /> CV assemblyV assembly C1/aesembty <br /> or disc edisc error disc <br /> 04ings 04NI; 0-rings <br /> seat KSeal tj Seed <br /> ❑ spring ❑ sw ng ❑ spring ' <br /> ❑ S'tewdGuide 0whragm(s) []'8*WGulde <br /> 0.tomer, OUw. pey. ❑ Otar,vw fy: <br /> ❑ Other,*&W. ❑ 011w.spew. ❑ 011ier,speo�y <br /> Final lost after repairs: Opened at Final WtFinal�te�st� <br /> ._�— psi _... iPsl --0-1� ISI <br /> Comments <br /> r. <br /> I hereby oertiy that this date is aoarrata end reflects the proper operation and maintenance of the assembly. <br /> tester-*Name: .•/ .It/ License#-Certification ti< 9�/�V l7'?r' <br /> Teller's Signature: Date: _-. A/0" _ <br /> Master Plumber; pave Lohmonn 2695PM t <br />