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N E WE C H <br /> COMPANIES, INC. 1633 Eustis Street <br /> St. Paul, MN 55108-1219 <br /> 51) 645-0451 Fax: (651) 642-5591 <br /> BACKFLOW PREVENTER TEST REPORT <br /> DATE: 9-0 9 <br /> Site Name: Orono Middle School Job# <br /> Zip Code: <br /> Site Address: 800 Old Crystal Bay Rd City: Orono 55356 <br /> Contact: John Ostlung Phone#: 612-919-1769 <br /> Owner: SAME Phone#: 952-449-8314 <br /> Owner Address: City: Zip Code: <br /> Serial#: <br /> Make/Model of Device:Watts 909 QT Size: 1" 501319 <br /> Serves What System: Boiler Make Up Water Location: Boiler Room <br /> Ck Valve Pres. Dif. Across Pres. Dif. when <br /> Ck Valve#1 #2 #1 Ck relief opens Strainer <br /> Leaked ( ) Leaked ( None ( ) <br /> Test before Repair Close -' Close PSI PSI Clnd <br /> Describe Repair t <br /> Final Test Materials Leaked ( Leaked ( ) None <br /> Used Close Close PSI PSI Ond <br /> CERTIFICATION: <br /> I hereby certify the foregoing data to be correct and that the tested device is functioning within the limits of the <br /> standards. <br /> FIRM NAME: NewMech Companies ADDRESS: 1633 Eustis Street St. Paul MN 55108 <br /> BY: CERTIFICATION#: PHONE: 651-645-0451 <br /> DATE: REMARKS: <br /> ( ) INSTALL TEST ( ) REBUILD ORIGINAL INSTALLATION DATE: 2000 <br /> DATE OF LAST REBUILD: 2005 <br />