HomeMy WebLinkAboutBackflow Preventor test report-2013 Dolder Plumbing & Heating, LLC.
f 7760 County Road #26 Maple Plain, MN 55359
-:: % Phone: 763-479-1942 Email: robdolder@aol.com
BACKFLOW PREVENTOR (RPZ) TEST REPORT
JOB ADDRESS: " � • /J �`` ��j /
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OWNERIOCCUPANT/CONTACT PERSON: / � �f /, ,�� CONTACT PHONE:
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DEVICE LOCATION: �� FLOOR#: � ROOM#:
SERVES WHAT SYSTEM: / -
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MAKE: MODEL#: SIZE: �� SERIAL#: C
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INSTALL DATE(MONTH/DAY/YEAR): OVERHAUL DATE(MONfiH/DAY/YEAR): TEST DATE(MONTH/DAY/YEAR):
(DO NOT PUT A FUTURE DATE IN THIS BOX)
11'Z�-Z� /3
#1 CHECK VALVE RELIEF #2 CHECK VALVE
PSI/DIFF PSI/DIFF
TEST BEFORE REPAIRS
FINAL TEST �, O �, � S �
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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&LAST NAME):
-r-7� oJB/��v CERTIFICATION NUMBER:
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STATE OF MINNESOTA
BAC;�FLOW kPZ TESTER UNLIMITED 'a±�sT��
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Licc�nse# 061486-BF '"�.��
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ExE;iration l�ate �. . V� �,�
Ori�inal Issued Date 04/16/1998 �.�� �,�'
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R�BERT W DOLDER
404 6REEN AVENUE SOUTHEAST
WATERTOWN, MN 55388
Dolder 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: � '"'� �• � �a zG� �� ) �^�� /
/ !r/ Z.J J �
OWNER/OCCUPANT/CONTACT PERSON: /� C,E�l� /``v Q s/.���LZ CONTACT PHONE:
Go rt�
DEVICE LOCATION: • FLOOR#: ROOM#: '
SERVES WHAT SYSTEM: �/� //C L��
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MAKE: /, � MODEL#: O� m SIZE: 3/ SERIAL#: ��
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INSTALL DATE(MONTH/DAY/YEAR): OVERHAUL DATE(MONfiH/DAY/YEAR): TEST DATE(MONTH/DAY/YEAR):
(DO NOT PUT A FUTURE DATE IN THIS BOX)
����9 Zo �3
#1 CHECK VALVE RELIEF #2 CHECK VALVE
PSI/DIFF PSI/DIFF
TEST BEFORE REPAIRS
FINAL TEST �J' , z s /'1 /, O
t� / C! �O
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 8 LAST NAME): '
� / CERTIFICATION NUMBER:
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STATE OF MINNESOTA
BAC�CFLOi! RPZ TESTER UNLIMITED �x�s
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Licc�nse# 061486-BF �e�:
Expiration l�ate �.. . V� �,�,'
Ori�inal Issued Date 04/16/1998 �.����
RQt3ERT W DOLDER
404 GREEN AVENUE SOUTHEAST
WATERTOWN, MN 55388