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& NowMoth <br /> COMP�I�S,m <br /> 1633 Eustis Street <br /> Saint Paul MN 55103.1219 BACKFLOW PREVE TEST REPORT 4715.2260 <br /> (651)645-0451 _ Annual Testing of <br /> DATE: W. 3 ° 6 R Valves <br /> Site Name: 0h0476 i`t e S'cAOO Job# 36/ RO <br /> . Site Address: V© 010 Cr s1 _ bci Rd Cly: Qron O Zip code: <br /> Z—o iin OS /vn Planed': - <br /> Owner: ' Phone#- • <br /> Owner Address: <br /> e and bp code: <br /> SIZE: SERIAL#: <br /> fiodel of kis 7o QT. • I `` Sol 31 <br /> LOCATION <br /> OF DEVICE: a f f ib() <br /> SERVES WHAT <br /> SYSTEM: 0 1 ' 1 Au . • U 4 L✓k e r <br /> Check Valve#1 Check Valve*2 Pres.DX P esj*. Strainer <br /> Across#1 When Relief <br /> Check I . - <br /> Before Close O Cbse AO PSI <br /> • <br /> Describe <br /> Final Leaked( ) <br /> T� . Close ( ) Close Leaked( <br /> ) '_ _ PSI ( )) <br /> Materialsand <br /> Used - . <br /> ERTIFICATION . <br /> herebY cerfrfy the foregoing data to be correct and that the tested device is func6onit0 mein the emits of the standards. <br /> _IRM NAME: NEWMECH CO.INC. • ADDRESS: 1633 EUSTIS STREET ST.PAUL INN.55108 <br /> A ��11 .i <br /> :Y: 'EAR/Oov e0`fx CERTIFICATION#: 6 G r PHONE: 651-645-0451 <br /> V <br /> ATE; `3 `O REMARKS: <br /> I INSTALL 'ST ❑ REBUILD ORIGINAL INSTALLATION DATE oZO Q 0 <br /> • <br /> DATE OF LAST REBUILD: o2OO�� <br /> PTR REV. 117/04- <br />