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REGULATED BACKFLOW ASSEMBLY (RBA) FORM/TEST REPORT <br /> Service Site Address <br /> 685 NORTH OLD CRYSTAL BAY RD, LONG LAKE, MN, 55356 <br /> Service Site Name <br /> ORONO INTERMEDIATE SCHOOL <br /> Work Order Number <br /> 272595 <br /> Contractor Name: Tester Name: <br /> Gilbert Mechanciki Contractors u Kenneth Thunder <br /> Contractor Address: Tester Certification #: <br /> 5251 W 74th Street, Edina, MN 55439 BF066234/ASSE 31412 <br /> Contractor License #: Test Equipment Manufacturer: <br /> 058808-PM WATTS <br /> Contractor Phone #: Test Equipment Model #: <br /> 952-835-3810 TK-9A <br /> Test Equipment Serial #: <br /> 853818 <br /> Testing Equipment Calibration Date: <br /> 05/10/2021 <br /> Backflow Assembly Detail Information (Check One:) <br /> Edi Double Check Detector Fire Protection <br /> Type of Work (Check One) <br /> Eli Test <br /> Manufacturer: System Serviced: <br /> Ames Fire supression <br /> Model # Location in Bldg <br /> 2000 SS Maintenence shop in Mechanical room <br /> Serial # Floor# <br /> 78106 1st <br /> Size (Inches) Room # <br /> 4" mechanical room <br /> REGULATED BACKFLOW ASSEMBLY (RBA) FORM/TEST REPORT cont. <br /> Reduced Pressure Principal or Reduced Pressure Detector Fire Protection (RP)-TEST RESULTS <br /> Check Valve #2 (Closed Tight) Shutoff Valve #2 (Closed Tight) Check Valve #1 <br /> Initial Test <br /> Final Test ®Yes <br />