2065 Cliff Rd - RPZ Test 2022-03-17MEW- M Z =� 0- -(=11 =
855 Highway 169 North
Plymouth, MN. 55441
(763) 531- 2000 Office
(763) 537- 4730 Fax
Back flow prevention certificate for RPZ
Owner/Occupant Contact person Trader Joes Contact Ph#
Address of Device: 2055 Cliff Road - Eaaan. MN 55122
Device location: Mezzanine
Floor #:
[Room #:
Serves what system: Cooling Tower
MAKE Watts
MODEL 919
SIZE 1"
SERIAL # 76412
INSTALL DATE
OVERHAUL DATE
TEST DATE
closed 7.6
03/17/2022
1
1 03/17/2022
DESCRIBE REPAIRS IF ANY: Install - permit EA172555
TEST DONE BY (PLEASE PRINT FIRST AND LAST NAME):
SCOTT GREENWOOD
CERTIFICATION NUMBER: 61363BF
COMPANY NAME: BUDGET PLUMBING CORP. CONTRACTOR LIC. #:MPLS 595 ST. PAUL 1079
#1 CHECK VALVE
PSI/DIFF
RELIEF
PSI/DIFF
#2 CHECK VALVE
TEST BEFORE REPAIRS
CONTACT PERSON: TOM MURULT
FINAL TEST
18.0
3.6
closed 7.6
DESCRIBE REPAIRS IF ANY: Install - permit EA172555
TEST DONE BY (PLEASE PRINT FIRST AND LAST NAME):
SCOTT GREENWOOD
CERTIFICATION NUMBER: 61363BF
COMPANY NAME: BUDGET PLUMBING CORP. CONTRACTOR LIC. #:MPLS 595 ST. PAUL 1079
COMPANY ADDRESS: 855 HWY 169
COMPANY PHONE#: 763-531-2000
CITY: PLYMOUTH STATE: MN ZIP: 55441
CONTACT PERSON: TOM MURULT
ATTACH COMPLETED TEST REPORT TO PLUMBING/GAS FITTING/RPZ PERMIT APPLICATION AND
SUBMIT WITH FEE.