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t <br /> NemMech <br /> CON S,WU <br /> 1633 Eustis Street 47152M <br /> Saint Paul MN 55108-1219 BACKFLOW PREVENTER TE <br /> �S <br /> T REPORT Annual Testing of <br /> (651)645-0451 DATE 7 – 2-8 ✓ R.PZ Valves <br /> PkN <br /> siteNarnw. /® Q, a Job# <br /> Site Address: �QQ PLO C-9 <br /> Mp COQ: <br /> ,l <br /> coma ��� P 6 - u <br /> Owner: ' Phone#: <br /> Owner Address: City: Zip code: <br /> and SIZE: �� SERIAL#: <br /> Mom°f w�•t TS Q 0% MOW <br /> 3 W <br /> DevlmLOCATION <br /> of DEVICE: �Ld, Q(OM <br /> SERVES WHAT �.. <br /> SYSTEM: fCc /M <br /> Check aloe#1 Check Valve#2 Pres.ME Pres.Of. Strainer <br /> Across#1 When Relief <br /> Check Opens <br /> Test Leaked( Leaked( _ PSI _ PSI None( ) <br /> Before Close ( ) close ( ) and ( ) <br /> Repair <br /> Describe <br /> Repair <br /> Final Leaked( Leaked( PSI PSI None <br /> Test Close p$, Close — — Cind ( ) <br /> NhtWals <br /> Used <br /> CERhFicKnom <br /> I hereby certifjr the foregoing data to be correct and that the tested device Is fi wdmft within the bft of the standards. <br /> FIRM NAME: dN,EWMECH CO.INC. ADDRESS: 1633 EUSTIS STREET ST.PAUL MN.55106 <br /> BY: 4 ("`� CERTIFICATION#: PHONE: 651-645-045T <br /> DATE: ' REMARKS• qq <br /> ❑ INSTALL9 EST ATI <br /> UILIJ ORIGINAL INSTALLATION DATE d^� <br /> DATE OF LAST REBUILD: OS <br /> BFPTR REV. 117/04 <br />