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FR�M : , � FAX N0. : Aug. 02 2006 04:55PM P5 <br /> � 762:Boone avrnue North � <br /> � E Broakl���i Park,lvf!M 554'_8 <br /> � �rd'n ��1Q Main76�,54�.4531 <br /> ��rrbi�l� W Fax."-63.595.4346 <br /> An Egan CompawY www.[p,'aaco-Clfar <br /> BACKFLOW PREVENTER TEST f�,EPOR.7" <br /> lnsvucUonS!o CertiEied Testers� Af�information must be 7 d or cfeari rinted fn black ink � <br /> S1TE ApDRESS• � ;/ C;!/ ZIP: ��'3 `� <br /> OCCUPANT: � �PHONE: TEST OATE: S�a <br /> ,/ Z� <br /> DEVICE MAKE/MO�EI�t/' � �S�ZE: � SERIAL NO. J�"� <br /> pEV(CE LOCATION_ � t36*e-� <br /> SYSTEM DEVICE ��� <br /> s�Rv�s: Gl�- (/ <br /> CHECK VALVE CHECK VALVE# PRES. DIF. PRES. OIF <br /> . #,� 2 ACROSS#1 WHEN RELIEF 5TRAINER <br /> CHECK ���N <br /> EST BEFOR�REPAlRS �KED O t�AKED O � ps� P51 NON�'r'� <br /> � CLOSED ( ) CLOSED( ) CLND( ) . <br /> FiNAL TEST CIOSED�/ CL�S ��si •��,psi <br /> /� . <br /> DESCRIBE � . <br /> REPAlR <br /> Certifiication: <br /> 1 hereby cettitY that the foregoing date to be correct and that the tested device is fur►ciioning <br /> witFftn the[imits of the sfandards. <br /> FIR ME: EGAN ECHANICAL CONTRACTORS ADDRESS: 7625 B�ONE AVE NO. _ <br /> � . <br /> TES�R'S CERTlFICATION#�00��31 PHONE#: 763-595-4300 <br /> Egaa Compsai�s,lnc. FAX#:763-595-Q�34-6 <br /> SIGNA7UREOFCERTIFI�D,T�� anAutpmattnn tnterClad � F+an enico ' <br /> £gat�Zvfechan�cdl ( Egsn-McKaY Electrical J ?dietz Flectric,lnc. I E8 � S 5 <br /> �a A�rmutive Ac�ioniFqua!Oppnrrunin'Fm,�1u��er <br />