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HomeMy WebLinkAboutbackflow preventer test d715.2260 Annual Testing of R.P.Z. Valves 6ACKFl01a PREVENTER TEST REPORT �. AooaEss 7�5� Si�'.����/�i���1jCITY ��.�� ztPs--..Sr3�� ( � �� „1 TEIEPHONE N0. OATE: 0}1N E R /-� � —,Iflf�fi�' �V � - /�/�l�c� �2%L`��O' i Svic.J �9 'S �i� KAKE ANO MOOEL OF OEYICE�s � LSIZE / � SERIAI N0. �/S � LOCATION OF DEYICE: �;�a�`.- D` �/�uSe O�rs�pe i � i-� ���vsr CHECK VALYE !1 CHECK YALYE t2 PRES. OIF. PRES. DIF. STRAINER acROss �� WHEN REIIEF � CHECK OPENS TESI IEAKED LEAJCEO _ S Dsi si C�ND �) BEFORE CLOSED ( CLOSEO (x� REPAIR DESCRIBE REPAIR FINA� LEAKED LEAKEO �psi _�si TEST CLOSED (y�. hWTERIALS - USED CERTIFICATION: ,. ,_ 1 hereby certify the foregoin9 data to be correct and that the tested device is �� functioning rri thin the 1 imits of LAe StandarCs. � F I Rt� NAME, ,�'.�1�Lurur3i lv ADDRESS ���� �i�'�u6aL�i�'v�� �,�s��� , � gY �f,�.l p%u�4s�•� TES7ER'S CERTIFICATION N0. �7� l TEL. N0. ��-�-��-/�� DAT E REFWRKS t�