HomeMy WebLinkAbout2017-07-17 RPZ Test Report JUL/18/2017/TUE 02:49 PM CORPORATE MECHANICAL FAX No. 7635333464 P. 002
REDUCED PRESSURE BACKFLOW PREVENTER TEST REPORT
AND TESTABLE DOUBLE CHECKS
Service,Name:kohl..)/f\ork-hoNcrr ContractPerson(rele:
Address:.5336 krve5er lair City:C>..1.. l-1e:jM.S
Stater Zip: S SoR.D
Device Location:SNi d I
l S hcce �c,{�-o�N;toliO Serve what system:
Account# Serial# 16555$0
Type:
Install Date: Make:t-..);lk.its Model: 92:VP_
Size:
Air Gap Installation Date:
NEW/OVERHAULED 0 Test Year 1 0 1 Test Year 2 0 1
Test Year 3 0 I Test Year 4 0 I
Rebuild Date: Test Date: 7-17-oZol7
Annual Check Valve#1 Check valve#2 Differential Pressure Relief Valve
Report Pressure 7 et Pressure 71 z Opened at 31 0 psid reduced pressure
Did not open
Repairs: ..
( X )Sign and date Tag �
The above.is'certified correct.Signed/ Date tested 7-O-.7
Tested by(Print Name)—'asoN ercA.SMA Certification Number Q4-Gx.., 72
'CORPORATE
MECHANICAL
5114 Hillsboro Avenue North
New Hope,MN 55428
Phone:(763)533-3070
Fax (763)533-3464
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