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HomeMy WebLinkAbout2012-08-03 Backflow Preventor (RPZ) Test Report - Norblom Plumbing Aug. 7. 2012 12:15PM Norblom Plumbing `( 5)) (. .0c, -ILio. 0441 P. 1 NORBLOM pLuMBNG 2p0 n ene 61 2.Avenue e 33 - Max 61 12- 27 .812 MN. w „ !� 1/S vero 81 venu So - tnneI' etIS ( I www.nerblemplumbing.aa m State PM# 5065 Minneapolis #788 Backflow Preventor (RPZ) Test Report Site Address: City: ( © Q6( p5 5v ,9 — J( 010 City: State: Zip: 0 P I-1 tAA. v") ' S 5 ( -)a -- --• Contact: Contact Phone: MAn6 S"l 6 ” C c/3 Devic Lo tion: Floor #: 1 04,5 t( t i,,,e. , ►.... Series What System: .� , ) p L h voe 1/0,..L Make: Model: Size: 5 0 0 , 61-- yz._, Serial #: _ Last Test Date: /.....3 I / / Install Date: Overhaul Date: i Test Date: ripill - - - 3) )2.____ 1 #1 Check Valve PSI /Dill Relief PSI /Dill #2 Check Valve Test Before Repairs: g Se O c) D I Final Test: Describe Repair /any pe inent notes (If any): Test Performed by:. Certification #: &.✓ 0 4'9 4 r 6 Norblom Plumbing Fax (612) 827-8129 2905 Garfield Avenue South , Web: www.norblomplumbing,com Minneapolis, MN 55408 Email: info©norblomplumbing.com (612) 827-4033 Jeff Norblom PM #5065 Minneapolis #788 Aug. 7. 2012 12:15PM Norblom Plumbing No.0441 P. 2 NoRBLOM pLuM. G 2003 NerUeld Avenue Souls . MUroeaoena, MN. \ N n + C///��L t Peeno www.norbIOm • Fax bNl$.0 827.0'129 V (� www.norwe meln0.cem State PM* 5065 Minneapolis #788 Backflow Preventor (RPZ) Test Report Site Address: I City: / - State: Zip: 54F-a Contact Contact Phone: tM, c G G .Z5 O93 Device Location: Floor #: A ktk, 630 Serves What System: T ✓fi St Make: Model: 17 5 YC Size: l l 1 Serial #: ,J kg ( -7 _ Last Test Date: 6/0<-5//( install Date: Overhaul Date: Test Date: - 1 I #1 Check Valve PSI /Diff Relief PSI /Diff #2 Check Valve Test Before Repairs: I Final Test: Describe Repair /any pertinent notes (If any): Test Performed by: Certification #: Norblom Plumbing Fax (612) 827 -8129 2905 Garfield Avenue South Web: www.norblomplumbing.com ' Minneapolis, MN 55408 Email: info@norblomplumbing.com (612) 827-4033 Jeff Norblom PM #5065 Minneapolis #788