HomeMy WebLinkAbout2024-07-25 Backflow Prevention Test Report \\ BACKFLOW PREVENTION TEST REPORT
Service Name IL-0N\ Contact Person
Address S CS k r -zr L ?J City o'-\L
State r^ -' Zip 6.- 0k6D,
Device Location 5\"-AA System Served1 5, ,oc
Type1�-Q Serial # i USS 9I
Install Date Make tN ,\\'- s Size a
ss
Test Date Model
Rebuild Date
Annual Check Valve#1 Check Valve#2 Differential Pressure Relief Valve
Report Pressure L1 Pressure ' Opened at psid
Repairs
( T ) Sign and date tag
The above is certified correct Signature 5 Date
Tested by printed name LVs‘-:--)r-Wv,,,D5L•r\ Certification #
CORPORATE
MECHANICAL
5114 Hillsboro Avenue North, New Hope MN 55428
Phone(763)533-3070
Email Service@corporatemechanical.com