Loading...
2015_0113 (2) C,�It`sC� �iVl�� 11��tI�A'I'�(3A3� 1)OMLSZ'IC � ���k��:&.,INE �� �VV F1E�EV'ENTION ASSEMBLY TES�' IV C� ItEPO�.T � �IAME QF PWS: C��(I �X t�VVS I.I3. # (���S S ns�l�,,,�r.,..l,�s � �.00ATION OF SERVICE: �� E � (�v�y. ��� k� UG (, �ll �X. �SC�� �j �he backfilo��� prevc►�t�on assemhly detailed below l�as �e�n testcd and o��aintaincd as required by ��CE(,� E-c��ulations and is certilied to !�� operating ���ithin acceptable pararneters. TYPE OF ASSENfBLY �` Reduc�Pressure Principle [� Pressure Vacu��reaker ^u Aoublc Check Valve � Aunosphere Vacuum Breal.er Maaufacz�uer W���JI S Size ��' Model Iv�ber �1 1SxL� Located At �,Iti'�er �C51'�r L�Ulp� s�;�N�b� w 3��-�G � ItEDUCED PRESSL'RE PRINCIPLE ASSEMBLY PRESSL�tE V�CUUM BREAKER � � Doubk C3eck v alve Assembi �� � y i i lst Chec3c 2nd Checi: Relief�alve :�r Ieitet Check Valve !� Ininal Test DC-Closed Closed Ti;ht � Opeaed at � Openad at _osid Ti�c � �( Leal:ed �] a•�psid osid �(+S-3 RP- ��,Dsid 7. 2 Leai:ed ❑ Did not Oprn ❑ Leal;ed o �� I and Materiats � i Used i Tcst After DC-Closed CaQsod Tight o Opened ae C?p�ed ac nsid Rtpair T�e�c ❑ nsid c�sid RP sid '�e above is ccxtifiQd to be�c, Fin�Namc A`� I�e� ce�isaa restar �►I'y� G o�� �i�Ad�ss u S�Ig �,�,���I� v;e�, �r� Cat �'�r xo. �Po�1��i� �ac� �' �3. l� F{- wUr�i' �6�'/`1 Gauge #� 0 5���615 llate last acc�r°acy Sested r _ ro- �y _.���- WY�awte -- �;�sto�aer"s (.c��y Yettow -- �:it.y Cc�py Pink - Tester's CoPY I