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r**%VeuFech <br /> OM ,NG <br /> 1633 Eustis Street 4715.2260 <br /> Saint Paul MN 55108-1219 BACKFLOW PREVENTER TEST REPORT Annual Testing of <br /> (651)645-0451 ^ ^ R.P.Z Valves <br /> DATE: <br /> Site Name:ORONO HIGH SCHOOL Job# <br /> Site Address:795 CRYSTAL BAY ROAD City: d Zip code:55356 <br /> Contact: JOHN OSLUND Phone# 952449-8314 I <br /> Owner.SAME Phone#: <br /> Owner Address: City: Zip code: <br /> Make and SIZE: SERIAL P. <br /> Model of WATTS 909 %" 415449 <br /> Device: <br /> LOCATION BOILER ROOM <br /> OF DEVICE: <br /> SERVES WHAT HEATING SYSTEM <br /> SYSTEM: <br /> Check Valve#1 Check Valve#2 Pres.Dif. Pres.Dif. Strainer <br /> Across#1 When Relief <br /> Check Opens <br /> Test Leaked( ) Leaked( ) _ PSI _ PSI None( ) <br /> Before Close ( Close ((r� !� Clnd ( ) <br /> Repair ` <br /> Describe <br /> Re-pair <br /> Final Leaked( Leaked( ) _ PSI _ PSI None ( ) <br /> Test Close O Close O 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: G ��f CERTIFICATION#: PHONE: 651-6454)451 <br /> DATE: �� REMARKS: <br /> ❑ INSTALL &--,C ST ❑ REBUILD ORIGINAL INSTALLATION DATE: �?600 <br /> DATE OF LAST REBUILD: <br /> BFPTR REV. 2/12/02 <br />