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EA189231 RPZ ReportCITY OF EAGAN MANDATORY INSPECTION OF BACKFLOW PREVENTER Test Reduced Pressure Zone Backflow Preventer Unit ID (Account #) I I PROPERTY I ADDRESS I CONTACT PERSON I PHONE # BACKFLOW PREVENTER INFORMATION Type Assembly Serial Number Model Size Manufacturer D'7 C DC [.F- A i Responsible Company Phone # Date of Last Rebuild Next Scheduled Rebuild Device Location Device Serves What System pan vtc-f ovtry BACKFLOW PREVENTER ASSEMBLY TEST Check Valve I O Leaked (v - Cl se Tight Check Valve 2 () Leaked (used Tight Press Diff Across Check Valve #1 , Z PSI Press Diff Across Check Valve #2 Press Diff Relief Open Describe Repairs PSI PSI I hereby certify the forgoing data to be correct and that the tested device is functioning within the limits of the standards. Firm Name: Northland Mechanical Contractors, Inc. License Number 059225-PM Test By: Signature Printed Name: Mike Calverley nt C4New Install ( ) Test ( ) Rebuild Address: 9001 Science Center Drive New Hope, Minnesota 55428 Certification #: BF708175 Date Tested: Z/ S' / Zv Z54 ( ) Replaced Unit PLUMBING PERMIT IS REQUIRED FOR ALL REPAIRS AND REBUILDS Date Copy to City