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JUL-11-2014 09:58 P.003 <br /> BACKFLOW PREVENTOR (RPZ) TEST REP'ORT <br /> Site Name: �.�a��� <br /> Site Address: ��� � �� <br /> Device Location on Site: (�Oa � � <br /> Contact Person: Irrigation by Design, Inc Phone: 763-559-7771 <br /> Serves What System: Irrigation <br /> Test Year (check one): �New Insta(1 a1st �2nd �3rd �4th �Overhaul <br /> Manufacturer Model Size Serial Number <br /> �n 25`� 2'� �0 3ood�b <br /> Install Date (nn��nr): Overhaul Date (Ml�n�): Test Date (M/D1Y): <br /> �a l �� �I�lr <br /> #1 Check Valve - psi Relief Valve - psi #2 Check Valve <br /> Test Before Repairs: <br /> Fi nal Test: ' 9� 3,�, ,� <br /> Describe Repairs, if any: <br /> Test Done By: �� Certification 2��� <br /> I � Number: <br /> {Print first and last name) <br /> Company Name: lrrigation By Design, Inc contractor NA <br /> l.icense: <br /> Company Address: 175 James Av. N. Company 763-559-7771 <br /> Phone: <br /> City: Minneapolis State: MN Zip: 55405 <br /> Contact Person: Lori Waters Phone: 763-559-7771 <br /> � : = �. SC <br /> ANNE <br /> � ��L� . D <br /> � <br /> March 2007 ��' 1��✓l � � �� ! � � <br /> HAUIBDForms/ExcelDocuments <br /> � � C �. - 7/W�'�1 r L.�.(/1 f �n <br />