Laserfiche WebLink
)y 520 Front Avenue <br /> D O O D St. Paul, MN 55117 <br /> Ph: 651-487-1061 <br /> MECHANICAL SERVICE Fax: 651-489-0141 <br /> I <br /> BACKFLOW PREVENTER TEST REPORT <br /> Address City OQOA)Q Zip <br /> j 0 Oxo allo 0l2CkI f1XQ RQ <br /> -C-444.--b-A4 <br /> Owner Contact Name Telephone <br /> /1/1&T. CG,,,NCl L <br /> Location Sy tem Served <br /> L (vv P6 c- w a x <br /> Make Model Serial Size <br /> 1.4.-)A Tr-544Z 282.4/ l ./ <br /> Inst�ILD�at�e <br /> Fjtbuill' Due Date <br /> RP Check Valve#1 Differential Pressure Relief Valve Check Valve#2 <br /> Assembly Leaked Opened at psid Leaked <br /> Closed Did not open Closed <br /> cc <br /> a <br /> w <br /> w <br /> Final Closed 6 r 6- Opened at L/ 2_- psid Closed '. 4 <br /> Test reduced pressure <br /> Double Check Valve#1 Check Valve#2 <br /> Check Leaked Leaked <br /> Valve Closed <br /> Closed <br /> cc <br /> a <br /> a <br /> w <br /> m <br /> Final Closed Opened at <br /> Test <br /> Pressure Check Valve Air Inlet <br /> Vacuum Leaked Did not open <br /> Breaker <br /> Closed Opened at <br /> 0) <br /> cc <br /> a <br /> a <br /> w <br /> cc <br /> Final Closed Opened at <br /> Test <br /> Comments/Notes: <br /> Sign and Date tag <br /> Certified Correct. Signed Date Tested: 5/1/4 <br /> 9 <br /> Tested by (Print Name) ler.4011 /4'- L6 Certification Number 4'2-V5Y-7 <br /> White-City Yellow-Customer Pink-Office <br />