HomeMy WebLinkAbout2013 - Backflow prevetor test report Dolder Plumbing & Heating, LLC.
7760 County Road #26 Maple Plain, MN 55359
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Phone: 763-479-1942 Email: robdolder@aol.com
BACKFLOW PREVENTOR (RPZ) TEST REPORT
JOB ADDRESS: ?�/] /� j/0 ,W/tA-e 4,10.1 dv ,j , i 5-51
OWNER/OCCUPANT/CONTACT PERSON Ld /� (e-----"/ /' J) CONTACT PHONE:
DEVICE LOCATION: 5/7,7r/n///� ,,,,,cc..",- /^ .----1 FLOOR#: / ROOM#:
SERVES WHAT SYSTEM: ,,// / 1k
A/Oh O/`i fes' Biu ,
MAKE: mitt- MODEL#: 9 57 E /2 SIZE: g SERIAL#: p3 40/iy,
INSTALL DATE(MONTH/DAY/YEAR): OVERHAUL DATE(MONTH/DAY/YEAR): TEST DATE(MONTH/DAY/YEAR):
(DO NOT PUT A FUTURE DATE IN THIS BOX)
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#1 CHECK VALVE RELIEF #2 CHECK VALVE
PSI/DIFF PSI/DIFF
TEST BEFORE REPAIRS
FINAL TEST
94., 2,
$ , 5
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(PLEASEPRINT FIRST LAST NAME):
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P� CERTIFICATION NUMBER:
STATE OF MINNESOTA
BACXFLOW kPZ TESTER UNLIMITED ;4es�q
License# 061486-BF ` ` •0
Expiration Date , J
Original Issued Date 04/16/1998
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ROBERT W DOLDER
404 GREEN AVENUE SOUTHEAST
WATERTOWN, MN 55388
bolder Plumbing & Heating, LLC.
7760 County Road #26 Maple Plain, MN 55359
Phone: 763-479-1942 Email: robdolder@aol.com
BACKFLOW PREVENTOR (RPZ) TEST REPORT
JOB ADDRESS: 3 /GJ '-T y /J00 "(155-1 ‘
OWNER/OCCUPANT/CONTACT PERSON: / 6.CONTACT PHONE:
DEVICE LOCATION: J ' P�ev FLOOR#: / ROOM#:-EA
SERVES WHAT SYSTEM:
MAKE: jC MODEL#: j / // /
�� � ' SIZE: / h SERIAL#: 772 t 5
INSTALL DATE(MONTH/DAY/YEAR): OVERHAUL DATE(MONTH/DAY/YEAR): GG TEST DATE(MONTH/DAY/YEAR):
(DO NOT PUT A FUTURE DATE IN THIS BOX)
l�_ZGJ-Ld/3
#1 CHECK VALVE RELIEF #2 CHECK VALVE
PSI/DIFF PSI/DIFF
TEST BEFORE REPAIRS
FINAL TEST 777 /�' /- a C (G Cs
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&LAS ?N ME):
CERTIFICATION NUMBER:
STATE OF MINNESOTA
BACKFLOW RPZ TESTER UNLIMITED �cFFsTa
en
License# 061486-BF
Expiration Date
Original Issued Date 04/16/1998 A.
ROBERT W DOLDER
404 GREEN AVENUE SOUTHEAST
WATERTOWN, MN 55388
bolder Plumbing & Heating, LLC.
7760 County Road #26 Maple Plain, MN 55359
Phone: 763-479-1942 Email: robdolder@aol.com
BACKFLOW PREVENTOR (RPZ) TEST REPORT
JOB ADDRESS: V!1 a),. - PA,fe L� ,74/
OWNER/OCCUPANT/CONTACT PERSON: ;4
1 CONTACT PHONE:
do r 11
ire
DEVICE LOCATION: FLOOR#: ROOM#:
SERVES WHAT SYSTEM: 6-44
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MAKE: /.)eat, MODEL#: SIZE: // SERIAL#: /��6 3?
INSTALL DATE(MONTH/DAY/YEAR): OVERHAUL DATE(MONTH/DAY/YEAR): TEST DATE(MONTH/DAY/YEAR):
(DO NOT PUT A FUTURE DATE IN THIS BOX)
/2-29-2420
#1 CHECK VALVE RELIEF #2 CHECK VALVE
PSI/DIFF PSI/DIFF
TEST BEFORE REPAIRS
FINAL TEST F 1 2 0
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(PLEA E PRINT FIRST&LAST NAME):
CERTIFICATION NUMBER:
STATE OF MINNESOTA
BAC FLOW RPZ TESTER UNLIMITED Fsrti�
License# 061486-BF AL4‘144
Expiration mate !�
Original Issued Date 04/16/1998
RO3ERT W DOLDER
404 GREEN AVENUE SOUTHEAST
WATERTOWN, MN 55388