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HomeMy WebLinkAbout2007 - Backflow preventer test reports Feb 26 07 06. 23a Mar Borns Ce11#612) 685- ( 952) 937-9185 p. 2 REDUCED PRESSURE BACKFLOW PREVENTER TEST REPORT AND TESTABLE DOUBLE CHECKS Service Name: 1/ LO`� L k-e Pore 4'101-. Contact Person/Tele M t .,'e ig ire"u ! I-0111-4 . ....5_3_5_e, �2' �r l Address: '-1O \Nt\lo w ar. M . City: I-4Vlfs. 1.r� kg. State: itAYl Zip: - So Device Location: M ez Z4 VI t N e2 . Serve what system: Pc PSS 4 re et-C, L Account Number:• Serial Number:- 1 Li 6 . 3 3 Type: Make: Wto. tf S Model:069 1 , Size: 1" Install Date: o 3 Air Gap Installation Date Rebuild Date: \ ) Test Date: g"pl L'—67 Check Valve #1 Check Valve #2 Differential Pressure Relief Valve Annual Report V CP 1 Pressure a Pressure U • / Opened at ,1 osid recuced pressure. Did not open - Cleaned Cleaned Cleaned Replaced Replaced Replaced R Disc Disc Disc; Upper E Spring Spring _ Disc. Lower P Guide - Guide Soling A Pin Retainer Pin Retainer __ Diaphragm; Large I Hinge Pin Hinge Pin Lower p Seat Seat Upper Diaphragm Diaphragm Diaphragm, Small Other, describe Other, describe _ , oter Uoper Seat. . Lower Upper Spacer, Lower Other, describe i L/1/Sign and date Tag The above is certified correct. Signed_ �� 44-4,00`--44-4,00`----f oDateTested: g ' a /9-077 Tested by (Print Name) Alt)er-l- Q YS (SYS Certification Number 06q,TIT 'j Corporate Mechanical, Inc. 5114 Hillsboro Avenue North New Hope, MN 55428 Phone (763)533-3070 Fax (763)533-3464 Feb 26 07 06: 23a Mar Borns Ce11#6121 685- (9521 937-9165 p. 2 REDUCED PRESSURE BACKFLOW PREVENTER TEST REPORT AND TESTABLE DOUBLE CHECKS Service Name: LCSYI Lake rete Deft, Contact Person/Tele M. I t\t' •gYOLU IN- 1- � Address: 31 ►N , t)W Of. kl , City: L-0^1. L4It. State: ,.1 n_ Zip: 55354 Device Location: Q+t'c I4\e ker KOOYYl Serve what system: I-a.wyy\ .�ri�A�t-" l 0A Account Number: Serial Number: g '7 a 118'5 ,,�_ U/ 1�a,, Type: Make: re loco Model: _ � Size: Install Date: o'3 Air Gap Installation Date L Rebuild Date: 1 0 Test Date: 39- ( ^6 7 Check Valve #1 Check Valve #2 Differential Pressure Relief Vaive Annual Report4 77 Pressure 7. Pressure 6, ( Opened at J. a osid recused pressure. Did not open - Cleaned Cleaned Cleaned Replaced Replaced Replaced R Disc Disc _ Disc; Upper E Spring Spring _ Disc, Lower P Guide Guide Spring A Pin Retainer Pin Retainer __ Diaphragm, Large 1 Hinge Pin Hinge Pin Lower R Seat Seat Upper Diaohraom Diaphragm Diaphragm, Small Other, describe Other,describe __- , yver — (Japer Seat: • Lower Upper Spacer, Lower Other, describe — i Sign and date Tag The above is certified correct. Signed 1/i C, /4,v DateTested: 31-07 L( '",V Tested by (Print Name) /7/he e`,_ 1 1- a lrs. D Certification Number (1.709o7i)7*-- . Corporate Mechanical, Inc. 5114 Hillsboro Avenue North New Hope, MN 55428 Phone (763)533-3070 Fax (763)533-3464 Feb 26 07 06: 23a Mar Borns Ce11#612) 685- ( 9521 937-9165 p. 2 REDUCED PRESSURE BACKFLOW PREVENTER TEST REPORT AND TESTABLE DOUBLE CHECKS • Service Name: "—all-- F I r Deft Contact Person/Tele ,"\ litt g Yo i-- Yl. / Address: 31-)0 IN i)IOw D . N. City: L-dllgL4k€ - State: Min Yl, Zip: w 65-35-0 Device Location: �l M ddey- 1O&YVl Serve what system:/ ,r�F�(' e -y-1A(-k "x )1 Account Number: Serial Number: D I'�- C I O 8 J I, Type: Make: Wa-H S Model: /c� (7S-RP Size: a Install Date: • n Air Gap Installation Date Rebuild Date: ell10 Test Date: -p( " O'/r� Check Valve #1 Check Valve #2 Differential Pressure Relief Valve Annual // p Report Pressure J, 6/ Pressure `7. Opened at •. osid recuced pressure. Did not open - Cleaned Cleaned Cleaned Replaced Replaced Replaced R Disc Disc _ Disc; Upper E Spring Spring _ Disc, Lower P Guide Guide Spring A Pin Retainer Pin Retainer __ Diaphragm, Large 1 Hinge Pin Hinge Pin Lower rt Seat Seat UQper Diaphragm Diaphragm Diaphragm, Smail Other, describe Other,describe _ _ L y,,,er Uoper .eat: Lower Upper Spacer, Lower Other, describe i Sign and date Tag5� -,[ The above is certified correct. Signed OL DateTested: [C -0.7rz)9 Tested by (Print Name) /7/ b er La rs nA Certification Number 00 g,2'7 r- Corporate Mechanical, Inc. 5114 Hillsboro Avenue North New Hope, MN 55428 Phone (763)533-3070 Fax (763)533-3464