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CORVAL GROUP- <br /> .01 <br /> /VBACKFLOW PREVENTER TEST REPORT <br /> DATE: y`v // 2?/7 <br /> Site Name: 0/i ,4& Job# /5i"/ <br /> Site Address?7O 7/a/ l/i �1 /, ity: P'' Zip Code: <br /> Contact: Phone#: <br /> Owner: Phone#: <br /> Owner Address: City: Zip Code: <br /> /r <br /> Make/Model of Device: x..,LA.ta 7 7O Size: T Serial#:h/C393 <br /> Serves What System: //-� /�r,�r Location: 80%/e ,ie_`7 <br /> Ck Valve Pres. Dif.Across Pres. Dif. when <br /> Ck Valve#1 #2 #1 Ck relief opens Strainer <br /> Leaked ( ) Leaked ) None <br /> Test before Repair Close (�C Close (c /CSI '"/PSI Clnd ( ) <br /> Describe Repair .Z /a1�- i _$ ��- /11-C1741/4/1 Z/7L <br /> Final Test Materials LeakedLeaked ,/ None <br /> Used Close (S Close ( (PSI "'7PSI Clnd <br /> CERTIFICATION: <br /> I hereby certify the foregoing data to be correct and that the tested device is functioning within the limits of the <br /> standards. <br /> FIRM NAME: Corval Constructors, Inc. ADDRESS:� 1633 Eustis Street St. Paul MN 55108 <br /> BY:‘20e.,#-;,/ ae. CERTIFICATION#: �/6 9b PHONE: 651-645-0451 <br /> DATE: e�// REMARKS: .�-ds /.. .5/ 4 v2V <br /> ( ) INSTALL ( )TEST (*REBUILD ORIGINAL INSTALLATION DATE: <br /> DATE OF LAST REBUILD: f //✓ 2o/9 <br />