RPZ 12.24.18 Dec 26 18 01:27p Artistic Plumbing 763-533-4410 p.2
BUILDING INSPECTIONS
6431 University Ave NE
rl Fridley, MN 55432
CITYOF Phone (763) 572-3604
FRIDLEY Fax (763) 502-4977
BACKFLOW PREVENTER TEST REPORT
Instructions to Certified Testers: All information trust be typed or Printed clearly in black ink..
SIVE ADDRESS: - ` ,i`I'n FRIDLEY, 1 N Z[P CODE: r S L 3-,4-
Q1NERfTENANT: - }g DATE: i' -Z - �
TELEPHONE: ta _5 r
MAKE & MODEL: SIZE: yz" SERfAL NEIMBER: 1 t4tf,C0a-
LOCATION OF DEVICE: -2,C; .
❑NEWIOVERHAULED ❑ TEST YEAR 1 ST YEAR 2 ❑ TEST YEAR 3 ❑ TEST YEAR4
CHECK VALVE CHECK VALVE PRES DIF PRES DIF WHEN
#I #2 ACROSS#1 RELIEF OPENS STRAINER
CHECK
TEST ❑ Leaked ❑ Leaked ❑ None
BEFORE REPAIRS _pst psi
iCLND
❑ Closed El
FINAL ❑ Leaked ❑ Leaked psi Z psi
TEST dosed a Closed
DESCRIBE 45 ``��
REPAIR: '� T (� OKI
* NOTE: WHFN REPLACINGIRENTOVING AN RPZ,PROVIDE SERIAL NUMBER OF RPZ BEING REPLACEWREMOVED
CERTIFICATION:
I hereby certify the foregoing data to be correct and that the tested devise is functioning within the limits of the
standards.
Artistic Plumbing, Inc.
6349 Quebec Ave N
Brooklyn Park,MN 55428
Plumbing Company: 763-537-9552 Lic.#062588-BF
Certified By: Certification#: Phone#:
ature)
OFr-""-E USE ONLY: