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"1�1ech <br /> , 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.PZ Valves <br /> DATE: ' <br /> Site Name:ORONO MIDDLE SCHOOL Job# <br /> Site Address:685 OLD CRYSTAL BAY ROAD City:ORONO Zip code: 55356 <br /> Contact: JOHN OSLUND Phone P 952-449-8314 <br /> Owner.SAME Phone P. <br /> Owner Address: City: Zip code: <br /> Make and SIZE: SERIAL# <br /> Model of WATTS / �® <br /> Device: <br /> LOCATION BOILER ROOM <br /> OF DEVICE: <br /> SERVES WHAT <br /> SYSTEM: <br /> Check Valve#1 Check Valve#2 Pres.Ulf. Pres.Dif. Strainer <br /> Across#1 When Relief <br /> Check Opens <br /> Test Leaked( ) Leaked( _ PSI _ PSI None( ) <br /> Before Close Close Clnd ( ) <br /> Repair <br /> Describe <br /> Repair <br /> Final Leaked( Leaked( PSI PSI None ( ) <br /> Test Close ( ) Close ( ) — — Cind ( ) <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: `// 2WK CERTIFICATION#:�����"r PHONE: 651-645-0451 <br /> DATE: ~�� REMARKS: �y�� <br /> ❑ INSTALL M,<0'2, <br /> ,/ST ❑ REBUILD ORIGINAL INSTALLATION DATE: �62Z <br /> DATE OF LAST REBUILD: <br /> BFPTR REV. 2/12102 <br />