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d715.2260 <br /> Annual Testing <br /> of R.P.Z. Valves <br /> 6ACKFl01a PREVENTER TEST REPORT <br /> �. AooaEss 7�5� Si�'.����/�i���1jCITY ��.�� ztPs--..Sr3�� <br /> ( � �� „1 TEIEPHONE N0. OATE: <br /> 0}1N E R /-� � —,Iflf�fi�' �V � <br /> - /�/�l�c� �2%L`��O' i Svic.J �9 'S �i� <br /> KAKE ANO MOOEL OF OEYICE�s � LSIZE / � SERIAI N0. �/S <br /> � <br /> LOCATION OF DEYICE: �;�a�`.- D` �/�uSe O�rs�pe <br /> i � i-� <br /> ���vsr CHECK VALYE !1 CHECK YALYE t2 PRES. OIF. PRES. DIF. STRAINER <br /> acROss �� WHEN REIIEF <br /> � CHECK OPENS <br /> TESI IEAKED LEAJCEO _ S Dsi si C�ND �) <br /> BEFORE CLOSED ( CLOSEO (x� <br /> REPAIR <br /> DESCRIBE <br /> REPAIR <br /> FINA� LEAKED LEAKEO �psi _�si <br /> TEST CLOSED (y�. <br /> hWTERIALS - <br /> USED <br /> CERTIFICATION: <br /> ,. ,_ 1 hereby certify the foregoin9 data to be correct and that the tested device is <br /> �� functioning rri thin the 1 imits of LAe StandarCs. � <br /> F I Rt� NAME, ,�'.�1�Lurur3i lv ADDRESS ���� �i�'�u6aL�i�'v�� �,�s��� <br /> , � <br /> gY �f,�.l p%u�4s�•� TES7ER'S CERTIFICATION N0. �7� l TEL. N0. ��-�-��-/�� <br /> DAT E REFWRKS <br /> t� <br />