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&% NowMoth <br /> 1633 Eustis Street <br /> Saint Paul MN 55108-1219 BACKFLOW PREVENTER TEST REPORT 4715.2260 <br /> A <br /> (651)645-0451 — Testing of <br /> DATE: . 3-0 6 RP-Z Valves <br /> Site Name: OP OA/0 i / ' S CAO• 'lob# 3 z0 <br /> Site Address: <br /> `l S o hd cry.5 ill d sy 1&, `lb': 0(=Zoi1/o zip code: <br /> .c«>tac So h h OsS [ v n J Ph.ii: q,oZ.- l l 9 - <br /> 3 4t <br /> Owner: • Phone#: <br /> Owner Address: Ckr: <br /> Make and code: <br /> SVE: ytt( SERIAL#: , - ...., <br /> LOCATION < < �( ` <br /> OF DEVICE: oder , coop-, <br /> SERVES WHAT . <br /> SYSTEM: t, ` e i .4 ' ♦ - V / K/ `t.1-e r - <br /> Check Valve#1 Check ante#2 Pres.Did Pres..Dif. Strainer <br /> • <br /> Amoss#1 When ReIlef <br /> Check <br /> Test Leaked( ) Leaked ) PSI OPens <br /> Before Gose ( ) .7,6 c .L__ P31None( ) <br /> �1 o cha ( ) <br /> Describe . <br /> R • <br /> Falai Leaked• () Close () — _ PSI allone <br /> d ( ) <br /> used - ( ) <br /> MaterialRTIFIGATIOR <br /> hereby certify the ng data to be and that the tested device is functlor ing within the tints of the standabs. <br /> IRM NAME NEWMECH CO.INC. - ADDRESS: 1633 EUSTIS STREET ST.PAUL MN.55108 <br /> Y: _ 3_ 0 6 CERTIFICATION#: 7 6 67- PHONE: 651-645-0451 <br /> • <br /> • <br /> A •TE t —3--ob-6 REMARKS: <br /> INSTALL TEST 0 REBUILD ORIGINAL INSTALIATION DATE 2_0 C) 0 <br /> • _ - • _ DATE OF LAST REBUILD: eZ G O s <br /> • <br /> PTR REV. 9/7104 <br />