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ewme ' <br /> R <br /> OOMPANEB,NG <br /> 1633 Eustis Street 47152260 <br /> Saint Paul MN 55108-1218 BACKFLOW PREVENTER TEST REPORT Annual Testing of <br /> (651)645-0451 -y r DATE: ;L88-Q r7 R.PZ Valves <br /> G <br /> V( <br /> Site Name: rQ ® S �� deal, Job# ZO <br /> SKeAddress: 5 o L er s��f3w Rp w- vrp�,ne0 tee: <br /> contac� t)9 Rn o 1,010'1. Phone#: <br /> Owner: Phone#: <br /> Oyaw Address: W. zip cwde. <br /> Make andSIZE: SERIAL.#. <br /> MOM°f �Device: wrfi 101 Li l.�rqq q <br /> LOCATION <br /> OF�cE: (3 ta, Le f Ko m <br /> SYTEMS WHAT ®` Le I pl-de, LO-P 1!✓ 'r¢✓ <br /> Check VaNe#1 Check Valve#2 Pres.Dif. Pres.M. Strallm <br /> Across#1 When Reef <br /> Check OPM _ <br /> Test Leaked Leaked Before (ase O close O — PSI — PSI CInd ( ) <br /> Rjxk <br /> Describe <br /> Repair <br /> Final Leaked( ) Leaked( ) — PSI PSI None- <br /> Test . Clow Close 2� 3.6_ <br /> CInd <br /> materials <br /> Used <br /> cERTIF�cAnav: • <br /> I hereby certify the foregoing data to be correct and that the tested device Is hindu ng within the limits of the standards. <br /> FIRM NAME: �NEOWMECH CO.INC. / ADDRESS: 1633 EUSTIS STREET ST PAUL MN 55108 <br /> BY. V J W" �r K CERTIFICATION#: a 6J PHONE: 651-645-045f <br /> DATE:, 2-5 J REMARKS: <br /> O INSTALL ;k-TEST 9REBUILD ORIGINAL INSTALLATION DATE �o® <br /> DATE OF LAST REBUILD: <br /> BFPTR REV. 117104 <br />