HomeMy WebLinkAboutBP17-088 OqX
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At-,yY 127-rT - of Backflow Prevention Device
r the year
Please use a separate farm for each device
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Annual t051-Complolo ParhA only
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SUMZo
Device Llarwfadunar Type o RPZ Mom Stu(in hdtes) Serial Number
lydarmauon 1.J�11L•tn� I VIOCV I 45a X� ! 2r' Co k7?!
Chu*VatVs Na t Check Valve No.2 OlRerardw Prossura Relief Lino Preaaula_del
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Teat _ ttUmkod t Date
Ware, Clesod tight �XJ mno tight tCl Opened at_ _Psld � ® [I
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Pressure drop adore first check vWvo M D Y
_3_V_paid
Describe Ropafred by
ttaplth and Name
makdale
used LIc 9
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1 � I�11T1 m � m
hl D y
Rraa)mat Do3ed bgtlt Grad light Opened at 3- psid 1 ' O S
Pressure drnp ache fast 1 N D Y
chack valve p.ad
Water Meter Nunbc Meier Reading Type of Sam=(check me)
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Ramorkn(0-aft dt,zdandea.0y;=u&uAets aII roteM t &.ka L m.be ae we arAm am poem d.ry.lz; a- .kg .•�)
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Name Oea
Prep"gw (a errs agent)0"Oreaton that la s was perfumed:
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1•*1.1 Name Tltlo Tel rpndne
CtJtificaticn that ifoWlaWn b In aearden m-0 the approved DLart& (To W maolewd by dr durpr cngbx
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1 hereby cnrt.�r OWorb k-a�an d Le i wan tAe approved plant•
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UcanaoNumEer 78721-1� P EUGE, D 'S)3378040 m d
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