2014_0328 (2)15 "1 C
1
li,ft DO 1:1J ESTR-1-- FIRELIN E.
3,t1.CXYLOW PREVEIVIION ASSEMMILY TEST .A.N-D NIA Ni" REPORT
T
GC.",' TON OF SF-R,11110E
el DLI A,I- (1, il-4-
-1-1 1, 1 ,el��i,��. i
awd 111,11111,1111ed as required by TCH)
III C
7Y?E OF ASSEMBLY
Reduced 11 to -ssure mc :Prcsswe Vac-irum Breaker
pe, Dcubi,- C"heck '11�,-Ive Atmosphere Vacuum Break-er
Size Q
M Located At frv-j 44f
ocqm -il F I t U,,�
Se11ai'.N'=be-A Ab
f
R.EDU'C_ED PRESSURE PRINCIPLE A.SSENfBLY
PRESSURE VACULTIM BREAKER
Doubie Cbe&- -Vaive.Assembiv
ist Check-
2nd Check
I Relief Valve
t Air Inlet
Check Valve
itiirlai t
x-C :Oset
i Closed Tlcht
►Opened at
Ooened ar
vsid
'
--ak:d
psid
id
i
1?_. -s'd
I -L C.)
C
Did not Open
C
Lzaked
R. , - C au's
I
an d
Test After
X-Closed
Closed Tight
Opened at
Opened at
psid
R,-pair
T;
I- eht
sid - PSIU
--psid
RT asAd
The above is ccxtEed "0 be true.
Tester 'Z� J
Firm Name I" Certified Tester
Finn Address -71 .-7 L04-ir- L-F-C-L C Cem Test= No. qq.3q Date 3-
Date las- accufacy tested
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy