2014_0328CA11C,K ,-)NE-
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FIRE LIN E
ASSEINSLY TEST.�' TENANCE REPORT
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nI.?-;7 OF ASSEMBILY
PLduc--d pressure ?r-inclpie Pr.-sswe Vac= Breaker
Dcubi.- '-h=k'Valve atmosphere Vacuum Breaker
flan ufaorzer G-)C,44--2 Size 31q
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REDUCED PRESSURE PRINCIPLE ASSENMLY
PRESSURE VACIMM BREA1aR
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Air Inlet
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FUM N ame Certified Tester 2JAM-1111, I/ "A t- 7
Firm Address eo bo -75--? Cert Tester No. OMI�6)3y D.I.
Gauge
Datc last accuracy tested iq
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy