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& NowMoth <br /> 1633 Eustis Street <br /> • Saint Paul MN 55108-1219 • BACKFLOW PREVENTER TEST REPORT 47152 <br /> (651)645-0451 / Annual Testing260 or <br /> DATE: �'—{0 0 6 R.PZ Valves <br /> Site Name: 0AOA/0 /'1 ZO IE -.S CLHOO 1 .,ob# <br /> . Site Address: It, 00 O(V cry sj 1 64y RO, ab D R ONO Zip code:S - <br /> . 3Oh n o STI vrk g Phone#: h i a- R I i- !i 6 <br /> Owner: - S 4. , Phone#: gcam- iii i c eo31 <br /> Owner Address: S Ain E <br /> CRY: ©RQ NO Zip code: <br /> - Make and • <br /> sly � � SERIAL#:o aA� QT <br /> it tte.e/ - .1 -30 t 1 <br /> LOCAYION OF OEYK:E: r & Ie( oeo <br /> SERVES WHAT -1 L (. ../n 7 e r 1 g ct+ h. <br /> SYS1T=Ik <br /> Check Valve#1 I Check Valve#2 Pres.DK Pry,pif. Steer <br /> Acnes#1 When Relief <br /> Check . OPens <br /> BBefore Close est LeakedO Close LeakedO -- PSI — PSI None( ) <br /> and Repair <br /> ( ) <br /> Describe <br /> Repair - <br /> final Leaked( ) <br /> - ) <br /> Close ( ) Close Leaked( ) — PSI PSI None(( ) <br /> ) <br /> MaterialsCktd <br /> Used - <br /> CER1IF9CATION: <br /> I hereby cel*the foregokv data to be correct and that the tested device is funcioning vain the Nnits of the standards. <br /> FIRM NAME: NEWMECH CO.INC. - ADDRESS: 1633 EUSTIS STREET ST.PAUL MN.55108 <br /> BY: t tliVl. 13 o U dive 'J-y CERTIFICATION#:-1 6,T PHONE: 651-645-0451 <br /> DATE Cd•.,.t•o—O C7 REMARKS: kulier i e v71 <br /> --d—k-.4- <br /> o INSTALL S.-TEST )(RFBUILD ORIGINAL INSTAi1ATION DATE -r-/ ,zs-"o2 O O 6 <br /> - . . - . . DATE OF LAST REBUILD: _ /0-,00 6 <br /> BFPTR REV. 917/04 - <br />