HomeMy WebLinkAbout2025-07-15 Backflow Prevention Test Report BACKFLOW PREVENTION TEST REPORT
Service Name koLld Contact Person
Address City 06,1,, Pc r1?
State (bra Zip S.,Sr.)2:72
Device Location ,Sheer c�.�t b�= '1� System Served
Type t P .. Serial # S54,1R0
,a
__Install Date __ _ Make k.A; Size__ 1I- __
Test Date 2- 15- 0O .3 Model i 2-'44--
Rebuild Date
Annual Check Valve#1 Check Valve#2 Differential Pressure Relief Valve
Report Pressure). % Pressure 2. -! Opened at a. psid
Repairs
( X ) Sign and date tag
The above is certified correct Signature Date 7-1 5 -�'
Tested by printed name Jason Brolsma_ Certification #_BF064272
CORPORATE
MECHAN1CAL
5114 Hillsboro Avenue North,New Hope MN 55428
Phone(763)533-3070
Email Service@corporatemechanical.com