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ROPED HYDRAULIC ELEVATOR ANNUAL SAFETY TEST REPORT Perform all tests per ANSI A17. 1 th 250 S 4 St Room 300 Minneapolis MN 55415 INSPECTION/TEST DATE ANNUAL TEST ELEVATOR NUMBER ID 5 YEAR TEST CAR ACCEPTANCE TEST PASS FAIL N/A BUILDING NAME STREET ADDRESS CONTACT PERSON/PHONE NUMBER TYPE OF ELEVATOR MANUFACTURED BY CITY OF MPLS ELEVATOR ID NUMBER CONTRACT SPEED SINGLE JACK FREIGHT PASSENGER CONTRACT CAPACITY TWIN JACK PISTON DIAMETER AREA SQUARE .

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