HomeMy WebLinkAboutRPZ test report-2008 CITY OF MINNEAPOLIS,REGULATORY SERVICES
INSPECTIONS DIVISION
_ 250 South 0 Street-Room 300
/ Minneapolis,MN 55415-1316
www.el.min neapolls.mn.us/onestop
BACKFLOW PREVENTOR (RPZ) TEST REPORT
JOB ADDRESS: -3 �s
v
OLVMER/OCCUPANTICONTACT PERSON: ��, 1� 1 CONTACT PHONE ?-?
Ci^ n
DEVICE LOCATION: Watt &00 FLOOR#: TROOM M
SERVES WHAT SYSTEM:
MAKE: �,/ MODEL#: c/-7 5-(, SIZE: SERIAL#: (1 �
INSTALL DATE(MONTHIDAYIYEAR): OVERHAUL DATE(MONTH/DAY/YEAR): TEST DATE(MONTH/DAY/YEAR):
#1 CHECK VALVE RELIEF #2 CHECK VALVE
PSUDIFF PSI/DIFF
TEST BEFORE REPAIRS
FINAL TEST -7.
DESCRIBE REPAIR IF ANY(IF THIS IS A NEW INSTALLATION AND REPLACES AN EXISTING DEVICE,INDICATE THE SERIAL NUMBER
OF THE DEVICE REMOVED):
TEST DONE BY(PLEASE PRINT FIRST&LAST NAME):
CERTIFICATION NUMBER: jj a
COMPANY NAME: OL G ( m ( co CONTRACTOR LICENSE#: 5:3 42 rM
COMPANY ADDRESS: ( -01 COMPANY PHONE M ♦( -31
CITY: �C .E STATE: (11 t'►! ZIP.55anl CONTACT PERSON/PHONE#: r G
ATTACH THIS COMPLETED TEST REPORT TO PLUMB[NG/GASFITTING/RPZ PERMIT APPLICATION AND
SUBMIT WITH FEE.
1/19/2006
f _ .