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1633 Eustis Street <br /> Saint Paul.Minnesota 55108-1288 <br /> kr— (651)645-0451 FAX:(651)642-5591 <br /> 7S Years of EneUence httpJ/www.newnwch.com <br /> 1633 Eustis Street 4716.2M <br /> saw Pau!MN 65108-12288 BAC KF—L—OW P emn nER TEST REM RT AmA Testing of <br /> (612)645-0451 R.PZ valves <br /> DATE 918 O l <br /> Site Name: ® © 0 0 L C% S C leo L Job# A AS O <br /> Sfte Aadvess: '' A)© zip code: — <br /> z, ti Phone A. <br /> Oma: Phone#: <br /> Owner Address: City: zip code: <br /> Makeandmodelot- s¢E: SERIAL : .y <br /> Dw1w. W f} ...5 C� G'� lI 8 © � c7 19 - <br /> LOCATION <br /> OF DEVICE: L <br /> SERVES WHAT <br /> SYSTEM: L <br /> Check Valve#1 Check Valve#2 Pres.DW. Pres.Dff. Stt <br /> Across#1 When Relief <br /> Check Onem _ <br /> Test Leaked( Leaked( — PSI — PSI Clad ( ) <br /> Rep* pose Ob we <br /> Dew&* <br /> R <br /> Prow Leaked( ) �( ) PSI CW ( ) <br /> Test Cbse ( ) <br /> Materials <br /> Used <br /> CERTIMCATION: <br /> I hereby mW the foregoing data to be corned and that tris tested device is Amobrft%**I the Iffft of the standards. <br /> FRM NAME; NEWMECH CO WC ADDRESS:, 1633 EUSTIS STREET ST PAUL MN 56108 <br /> BY: CERTIFICATION#: ®^ PHONE.- <br /> DATE• REMARKS: <br /> O WSTALL WTESTO REBUILD ORIGINAL WSTALLATION DATE: <br /> DATE OF LAST REBUIIA: <br /> BFPTR REV. WM <br />