HomeMy WebLinkAbout2012-01-27 Backflow Preventor (RPZ) Test Report - Trash Room 02/01/2012 09:15 7634752566 PAGE 02/02
BACKFLOW PREVENTOR (RPZ) TEST REPORT
JOB ADDRESS: / 7 5 ^ 73-- (3 - 8 )th
OWNER/OCCUPANT /CONTACT PERSON: 14Alti / r / � chill „✓�
- ---- -- `j/ CONTACT PHONE:
DEVICE LOCATION: FLOOR #: ROOM #:
SERVES WHAT SYSTEM:
prl h l�e�r sys
MAKE: /fi'�'1ei.�j MODEL #: srepo 811 R. R SIZE: f . N SERIAL #: o
INSTALL DATE (MONTH / DAY/YEAR): OVERHAUL DATE (MONTH/DAY/YEAR): / TEST DATE (MONTH /DAY/YEAR):
( DO NOT PUT A FUTURE DATE IN THIS BOX)
*1 CHECK VALVE RELIEF #2 CHECK VALVE
PSI /DIFF PSI/DIFF
TEST BEFORE REPAIRS
FINAL TEST , / 7 y f�7
DESCRIBE REPAIR IF ANY (IF THIS IS A NEW INSTALLATION AND REPLACES AN EXISTING DEVICE, INDICATE THE SERIAL NUMBER
OF THE DEVICE REMOVED):
R Pz-
TEST DONE BY (PLEASE PRINT FIRST & LAST NAME):
CERTIFICATION NUMBER: /
COMPANY NAME: �e/id ,i sOp1 !' JL) 4 A /' 1 CONTRACTOR LICENSE #: O.S93225g
COMPANY ADDRESS: 3Y/0 n ./ M p k.1 e- ) COMPANY PHONE #: 7/3
CITY: UyN"0d STATE: //rte ZIP : CONTACT PERSON /PHONE#: 73'04
ATTACH THIS COMPLETED TEST REPORT TO PLUMBING /GASFITTING/RPZ PERMIT APPLICATION AND
SUBMIT WITH FEE
10/2/2007
02/01/2012 09:15 7634752566 PAGE 01/02
Weld and Son's Plumbing Inc.
763-475-0296 / fax 763 -475 -2566
FAX COVER
Date: ,2-/-
To: r,4- , /- Dep f 6sl- 4/3 9- Cs7V
From: Tim Mohr /
timmAweldandsons.com
Re: RPz %e-sf re-so /7
Message: e io !/ow : ;p Auie. i s a-
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