HomeMy WebLinkAboutRPZ Tes Results Trails Of Orono.ASSOCIATED
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1257 Marschall Road, P.O. Box 237
Shakopee, MN 55379
Phone: (952) 445-5100
Fax: (952) 445-5119
E-Mail: criechers@associatedmechanical.com
REGULATED
BACKFLOW ASSEMBLY (RBA) APPLICATION FORM/TEST REPORT
COMPLETE JOB ADDRESS (INCLUDE
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Apt/Unit it) NAME OF BUILDING, OWNER/OCCUPANT, CONTACT NAME AND PHONE NUMBER
, Gv T
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APPLICANT COMPANY NAME
Associated Mechanical
CONTRACTOR LICENSE # CONTACT NAME AND PHONE NUMBER
Contractors
L098 22749 Charlie Riechers 952-445-5100
ADDRESS
PO Box 237
CITY STATE LP EMAIL
Shakopee MN 55379 criechers associatedmechanical.com
TESTER NAME
Dave Muellerleile
TESTER CERTIFICATION # PHONE
754900 - 43711 952-445-5100
TEST EQUIPMENT MANUFACTURER TEST EQUIPMENT MODEL #
TEST EQUIPMENT SERIAL#
TESTING EQUIPMENT CALIBRATION DATE
Midwest
845-5
05210140
Mo. 4 yr 24
TYPE OF WORK AND FEE INFORMATION (check one)
_Install _Relocate
Remove Replace and SN# of Replaced Device
Rebuild _✓ Test
Describe parts and repairs when neeoe�•
of information Provided by me to bz ect and th e t device Is fu ctionfng in compU
l }ureby cerify the foreg r�B ///
C:E.RTIflUI�� ��� TESTERS SIGNATURE
C>�e �apter 4714. ILGC ._--BEST DATE• �3 Lcf
State of