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Home My WebLink Aboutbackflow test report I � _ R�,��`��ED ��Q � �� , .; „ �6 JUI� r... � �0 CIN �� 'R�N� BACKFLOW PREVENTOR (RPZ) TES� REPORT JOB ADDRESS: �� I v �:� �� ,.�� . OWNER/OCCUPANT/CONTACT PERSON: � CONTACT PHONE: �� DEVICE LOCATION: � , 'L� ' ��r FLOOR#: ROOM#: SERVES WHAT SYSTEM: ��.� ' , � �� MAKE: �� MODEL#: n�L�,� -� SIZE: � SERIAL#: �/� �a EJ 0 ' INSTALL DATE(MONTH/DAY/YEAR): OVERHAUL DATE(MONTH/DAYIYEAR): TEST DATE(MONTHlDAY/YEAR): (DO NOT P FUTURE DATE IN THIS BOX) ��=�L � _ �� #1 CHECK VALVE RELIEF #2 CHECK VALVE PSI/DIFF PSI/DIFF TEST BEFORE REPAIRS FINAL TEST �� L.. � �J J� ��1.�� / DESCRIBE REPAIR IF ANY(IF THIS IS A NEW INSTALLATION AND REPLACES AN EXISTING DEVICE,INDICATE THE SERIAL NUMBER OF E DEVICE REMOVED): S � � �� l � 15�� l- C�� , � � -�� , TEST DONE BY(PLEASE PRINT FIRST&LAST NAME): CERTIFICATION NUMBER: 65646BF CHAD FISKEWOLD connPaNY NaMe: BLAYLOCK PLUMBING COMPANY MPLS CONTRACTOR LICENSE#: 0632OOPM COMPANY ADDRESS: 7731 4TH AVE S COMPANY PHONE#: 612-$69-7531 c�TY: RICHFIELD STATE: MN Z�P: 55423 CONTACT PERSON/PHONE#: ROBIN