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i?�/20/2009 20:47 7637672855 DALE BOCAN PAGE 05/07 <br /> , ' , . <br /> � f���j�'IV�D ?625 BOOnc A.veque North. <br /> • ,� � • 8rooklyn Park,MN 55428 <br /> � �gar� Ser�ice , . 2009 Main 763.544.4•131 <br /> � �'�� � �{ �ax 763.59�.4346 <br /> � An EgaA Compaay www.�ganco.cru,i <br /> - . , cinr oF oRorvo .: <br /> BACKFLOW PREVENT�R TEST,REPOR.T . , <br /> � fnstructions to Certified Testers: All information must be T ed or cleari rinted ir�bl�,c(c ink . <br /> ' ��, �,� Z1P: � <br /> Sf?�RDDRESS: �v�-� I�I.I . <br /> OCCUPANT!/l�i1 �rt�� �� PHONE:. � TEST DATE: �--e� <br /> , rr � . <br /> DEVICE MAKE/MODEL:� d�l � ��Z�= � � SERIAI�NO. I J <br /> �"� ��.fi �/ <br /> DEVICE �OCAT[ON; � ..�' �� <br /> SYSTEM DEVIGE /�� ,�% ���c� � <br /> . ��_. G•ci�..f�.+� v.� /-e°�" .. . _ _.. <br /> SERVES. ��� 'd`-"' ` . <br /> PR�S. DIF. � PRES. pl� � <br /> � � CHECK VALVE CHECK VALVE# ACROSS#1 WHEN RELIEF STRAINER <br /> � #� z CHECK OPEN <br /> (�EAKED( ) L.�AKED ( } . . NONE - <br /> EST S�FpRE REPAIRS CLOSED ( ) CLOSED ( ) pS� psi CLND ( ) . <br /> F1NAL TEST CLOSE�--�• Ci.OS�D� �!j�ps� ��psi . <br /> DESCRlBE � � <br /> REPAIR � ' <br /> Certification: • � <br /> 1 hereby certlfy that the foregoing date to be correct and that the tesfeci.device 1s tunctioning <br /> � withir�the limlts of the standards. • • • <br /> FfRM NAM�: EGAN MECHANICAL CONTRaGTORS ADDRESS: 7625 BQONE AVE. NO. _ <br /> gy; �. c� TEST�R'S CERTiF1CATION # 7 PH4NE #: 763�595-4300 � <br /> . " . . $gart CoJmpanies,inc. • FAX #: 763-595-4346 <br /> ' S1Q/�fATURB OF CPFl�tFIED TEST61i <br /> Egan Mechanical,1 Egsn-McKay Electricat I Nietz ElectFic,(nc. � Egan Autamaciote I InterClad � Egan Service � <br /> ,�Jp�J(jmmative.letion/Equof ppporruteity E�npfoyer ' , • � <br />