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f , <br /> AWL Allk <br /> 'IL ewmech <br /> COMPANIES, NG <br /> 1633 Eustis Street 4715.2260 <br /> Saint Paul MN 55108-1219 BACKFLOW PREVENTER TEST REPORT Annual Testing of <br /> (651)645-0451 DATE: R.P.Z.Valves <br /> �! � � 7 <br /> Site Name: O QI D �G Job# C <br /> Site Address: G &0 City: 61W&Q <br /> Zip code: 361 <br /> Contact: Phone#: <,-z _ _kA <br /> Ogen Phone#: <br /> Owner Address: City: Zip code: <br /> Make and SIZE: SERIAL#: <br /> Model W n <br /> Device: I�� <br /> LOCATION <br /> OF DEVICE: ` �o <br /> SERVES WHAT <br /> SYSTEM: 1�= l' <br /> Check Valve#1 Check Valve#2 Pres.Dif. Pres.Dif. Strainer <br /> Across#1 When Relief <br /> Check Opens <br /> Test Leaked( Leaked( _ PSI _ PSI None( ) <br /> Before Close Close Clnd ( ) <br /> Repair <br /> Describe <br /> Repair <br /> Final Leaked( Leaked( _ PSI _ PSI None ( ) <br /> Test . Close O Close O Clnd ( ) <br /> Materials <br /> Used <br /> CERTIFICATION: <br /> I hereby certify the foregoing data to be correct and that the tested device Is functioning within the limits of the standards. <br /> FIRM NAME: NEWMECH CO.INC. �ADDRESS: 1633 EUSTIS STREET ST.PAUL MN.55108 <br /> � � 'l P <br /> BY: �/�l CERTIFICATION#: / HONE: 651-645-0451 <br /> DATE: l�P' "( RE MARKS: <br /> ❑ INSTALL 0-4tST ❑ REBUILD ORIGINAL INSTALLATION DATE: I.LJI <br /> DATE OF LAST REBUILD: <br /> BFPTR REV. 1/7/04 <br />