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,, SSOCIATED ReCweo <br /> MAY�� <br /> mechanical contractors, inc. C,�.�, '6 2Op oR 012 <br /> 1257 Marschall Road, P.O. Box 237 • Shakopee, MN 55379 <br /> Phone: 952/445-5100 Fax: 952/445-5119 <br /> BACKFLOW PREVENTOR (RPZ) TEST REPORT <br /> JOB ADDRESS: -.. / �, <br /> 875.......S u��, /i�- ,j/r1� C�:, ` Gs1/%/ 53—T5-6_; <br /> OWNER/OCCUPANT/CONTACT PERSON: 65 4 CONTACT PHONE: <br /> G9.11 S,".si, ,e <br /> DEVICE LOCATION: /Ae„,,,,i,„ �QCr Ctii FLOOR#: ( ROOM#: <br /> SERVES WHAT SYSTEM: <br /> ' `/e- ' 17--"L 6 3' 5. 7%/4/ <br /> MAKE:,�y t/ MODEL#: j�' L_ SIZE: SERIAL#: .gbzt ✓ <br /> INSTALL DATE/(MONTH/DAY/YEAR): OVERHAUL DATE(MONTH/DAY/YEAR): TEST DATE(MONTH/DAY/YEAR): <br /> #1 CHECK VALVE RELIEF #2 CHECK VALVE <br /> PSI/DIFF PSI/DIFF <br /> TEST BEFORE REPAIRS / 5 c /:7.ec <br /> FINAL TEST n [� / <br /> DESCRIBE REPAIR IF ANY: <br /> ?cel /A-7_59"A- G Z--- <br /> TEST DONE BY(PLEASE PRINT FIRST&LAST NAME): <br /> CERTIFICATION NUMBER: <br /> 5-<Fc, /7 ' , .c' c ,.. 7R/ <br /> COMPANY NAME: CONTRACTOR UCENSE#: P N C$ crq I I <br /> COMPANY ADDRESS: COMPANY PHONE#: <br /> CITY: STATE: ZIP: CONTACT PERSON/PHONE#: <br />