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JUL-11-2014 09:57 P.002 <br /> BACKFLOW PREVENT�R (RPZ} TEST REPORT <br /> Site Name: 5 <br /> .� <br /> Site Address: �7 <br /> 0 C�, 1' r c� �ra��i <br /> Device Location on Site: Zt�-�c ������ �-n �. L� , . <br /> Contact Person: Irrigation by Design, Inc Phone: 763-559-7771 <br /> Serves What System: Irrigation <br /> Test Year(check one): �New Install�1st �2nd a3rd �4th �Overhaul <br /> Manufacturer Model Size Serial Number <br /> t,../r l 1'��L�S ��✓ X� '�'' ���Z I'�� <br /> Install Date (M/DIY): Overhaul Date (MIDIY): Test Date (M/D/Y): <br /> l0 3� r�- � g � <br /> #1 Check Valve - psi Relief Valve - psi #2 Check Valve <br /> Test Before Repairs: <br /> �inal Test: � .� ,� � n <br /> 1' <br /> Describe Repairs, if any: <br /> Test Done By: 1 Certification <br /> N- ��l Number. 2�Z�� <br /> ( rint first and last name) <br /> Company Name: Irrigation By Design, Inc Contractor NA <br /> License: <br /> Company Address: 175 James Av. N. Company 7g3-559-7771 <br /> Phone: <br /> City: Minneapolis State: MN Zip: 55405 <br /> Contact Person: Lori Waters Phone: 763-559-7771 <br /> � � ` ' �� <br /> A� a � �� f� AN <br /> N� <br /> D <br /> March 2007 ���(� � I �� (��l <br /> HAL/IBDForms/ExcelDocuments <br /> -� Q'S z -'��G1 - �-C� � tv <br />