HomeMy WebLinkAbout2017-08-16 Cross Connection Control Device Performance Test Reports - Interstate Testing 2017.08.18 04:25 PM Interstate Testing 7637555365 PAGE. 17/ 20
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Cross Connection Control Device Performance Test
interstate Testing
2940 141st Ave.NW.
Andover Mn.66304
Phone(763)744-6149
OWNER INFORMATION ••
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COMMENTS
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I HEREBY CERTIFY THE TEST RESULTS ARE TRUE AND THE TEST WAS CONDUCTED BY ME PERSONALLY.
Teeter Name(print) 7)0 el r-1 PI i/,/-.g.1- RecitettatIon No.a 6 C 3-2 3 8-Friree ot Day
Tubs Signature(,2"...„. f---L-e-Ct Phone No.763 Date
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2017 . 08 . 18 04 : 28 PM Interstate Testing 7637555365 PAGE. 12/ 20
, � . Cross Connection Control Device Performance Test
interstate Testing
2140 141st Ave. NW.
Andover Mn. 68304
Phone(763) 7444149
SER INFO-W.'A •.. . .
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coMMENTS
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I HES CERTIFY THE TEST RESULTS ARE TRUE AND THE TEST WAS CONDUCTED BY ME PERSONALLY.
Teeter Nam(print) 7)a ►-1 i i M" Registration No.0653.23 ' 'Films of Day
Tester Signature c2 d` -1 —e- Phone No.76.3 Date P)aV 1l
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