2013_1105CHECK ONE:
IRRIGATION_
FIRELINE
NAME OF PWS:
CITY OF COPPE, LL
I
PWS I.D. h! AA
LOCATION OF SERVICE: 10
REM
White -- Customer's Copy Yellow - City Copy Pink - Tester's Copy
REDUCE, D PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VACUUM BREAKER
Double Check Valve Assembly
Ist Check-
-- ---------- — ._::C
[2nd Check
Relief Valve
—
Air Inlet
Check Valve
-
Initial Test
DC-Closed
Closed Tight
e
Opened at
Opened at
usid
Tight
Leaked
0
__psid
...... psid
Lealced
Did not Open a
Leaked
Repairs
and
Materials
Used
Test After
DC-Closed
Closed Tight
C3
Opened at
Opened at
______psid
Repair
Tight
-------psid
__psid
-
R.Pe��—
White -- Customer's Copy Yellow - City Copy Pink - Tester's Copy