HomeMy WebLinkAboutbackflow preventor test JUL-11-2014 09:57 P.001
BACKFLOW PREVENTOR (RPZ� TEST REPORT
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Site Address: 1 �
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Device Location on Site: � �n�`�
Contact Person: Irrigation by Design, Inc Phone: 763-559-7771
Serves What System: Irrigation
Test Year(check one): �New Installalst �2nd �3rd �4th a0verhaul
Manufacturer Modei Size Serial Number
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Install Date (M/�/Y}: Overhaul Date (M/�IY): Test Date (nn/�/Y}:
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#1 Check Vaive- psi Relief Vaive - psi #2 Check Valve
Test Before Repairs;
Fina! Test: �5 2�� � ,
Describe Repairs, if any:
Test Done By: l ) Certification
�a� l�l�C��t l}(�S Number. �'4 �D �
(Print first and last name}
Company Name: Irrigation By Design, Inc Contractor NA
License:
Company Address: 175 James Av. N. company 763-559-7771
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Phone:
City: Minneapolis State: MN Zip: 55405
Contact Person: Lori Waters Phone: 763-559-7771
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