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2441 VENTURA DRIVE • SUITE 100 <br />KRAFTC4 WOODBURY, MN 55125 <br />MECKANICALL.L.C. MAIN: 651-773-9000 FAX:651-773-9010 <br />BACKFLOW PREVENTER TEST REPORT <br />Owner <br />ontact Name i ne <br />Addres <br />v , <br />o Oro � !� <br />2 cityy VV <br />Zip <br />/Q✓,J <br />Make r <br />; s M <br />jie�ri�azw <br />Size t0 <br />Install Date <br />Rebuild Due Date <br />� � <br />Location <br />System Served <br />Check Valve #1 <br />Differenti I Pr sure Relief Value <br />Check Valve #2 <br />RP <br />Assembly <br />Leaked 42eOpened <br />Closed -7 <br />Leaked <br />Closed <br />at dg psid <br />Did <br />not open <br />o: <br />a <br />w <br />o: <br />Final <br />Closed _ <br />Closed <br />Opened at psid <br />Test <br />reduced ressure <br />Double <br />Check Valve #1 <br />Check Vafve #2 <br />Check <br />Leaked <br />Leaked <br />Valve <br />Closed <br />Closed <br />a <br />Lu <br />o= <br />Final <br />Closed <br />Closed _ a� <br />Test <br />Pressure <br />Check Valve <br />Air Inlet <br />Vacuum <br />Leaked <br />Did Not Open <br />Breaker <br />Closed <br />Opened At <br />U) <br />Cr <br />A< <br />. <br />w <br />o= <br />Final <br />Closed <br />Opened At <br />Test <br />— <br />Comments/ Notes: <br />/ JJ Sign and Date tag <br />Certified Correct. Signed�� ! -o�p— Date Tested: I� <br />Tested by (Print Name), it V i� ! ` Cif-C�,certification Number �[1W <br />White - City Yellow - Customer Pink - Office <br />