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JUL-11-2014 09:57 P.001 <br /> BACKFLOW PREVENTOR (RPZ� TEST REPORT <br /> Site Name: �` 1 <br /> STl�'if�,`�.�C.�� <br /> Site Address: 1 � <br /> C.�2.1 w Q, <br /> Device Location on Site: � �n�`� <br /> Contact Person: Irrigation by Design, Inc Phone: 763-559-7771 <br /> Serves What System: Irrigation <br /> Test Year(check one): �New Installalst �2nd �3rd �4th a0verhaul <br /> Manufacturer Modei Size Serial Number <br /> ��,1�{.� �'l.5 Y 2.'' �a 31� <br /> Install Date (M/�/Y}: Overhaul Date (M/�IY): Test Date (nn/�/Y}: <br /> ~l I � 1 iti `��� �� <br /> #1 Check Vaive- psi Relief Vaive - psi #2 Check Valve <br /> Test Before Repairs; <br /> Fina! Test: �5 2�� � , <br /> Describe Repairs, if any: <br /> Test Done By: l ) Certification <br /> �a� l�l�C��t l}(�S Number. �'4 �D � <br /> (Print first and last name} <br /> Company Name: Irrigation By Design, Inc Contractor NA <br /> License: <br /> Company Address: 175 James Av. N. company 763-559-7771 <br /> „� <br /> Phone: <br /> City: Minneapolis State: MN Zip: 55405 <br /> Contact Person: Lori Waters Phone: 763-559-7771 <br /> . �Y�� = P•v� <br /> ' ` S <br /> CANN <br /> ED <br /> � March2007 /�(/�,�� � � � � } , � HAUIBDForms/ExcelDocuments <br /> �G�S 2�Z�-I�1 - �(a l (p <br />