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'IL <br /> ewMech <br /> 't COMPANIES, NC <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 /> U <br /> Site Name: D,*eo ffn �G 4DD / Job# <br /> Site Address: 6 go1w <br /> City: 6fio&0 Zip code: <br /> Contact: Phone#: _ <br /> Owner. Phone M <br /> Owner Address: City: Zip code: <br /> Make and SIZE: SERIAL#: <br /> Model of 3 6 65 D <br /> Device: g, / <br /> LOCATION /,/� <br /> OF DEVICE: /L �i� <br /> SERVES WHAT _ <br /> SYSTEM: 4/ gal <br /> 'Check Valve#1 Check Valve#2 v Pres.DIf. Pres.Dif. Strainer <br /> Across#1 When Relief <br /> Check Opens <br /> Test Leaked( Leaked( _ PSI _ PSI None( ) <br /> Before Close O Close OClnd ( ) <br /> Repair 21 -17 < <br /> 7 <br /> Describe <br /> Repair <br /> Final Leaked( Leaked( _ PSI _ PSI None ( ) <br /> Test . Close ( ) Close ( ) 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 /> BY: �L �� �7�i CERTIFICATION#: 0/64(Z PHONE: 651-645-0451 <br /> DATE! / ©`f RE MARKS: n <br /> ❑ INSTALL CT'TEST ❑ REBUILD ORIGINAL INSTALLATION DATE: "J ty//) <br /> DATE OF LAST REBUILD: C� <br /> BFPTR REV. 1/7/04 <br />