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2014-0903 CtIEC� (JNI�: IRRIG�TIC)N � llObiEST1C FIRELINE B�Ck'FLOV�/PREVE�V'I'ION ASSEMBLY TEST ANU MAINTENANCE REPORT NAME OF PWS: �-r �`l C' (` i�O��-c� PW5 I.D. # LOCATIO?ti OF SERVICE:� ��� ��-�1%��� �T�l�� h<<ckl�l��«� pre���ntiun ��ss�mbl��detailed b�lo��� has bten t�;t:d and maintained as requirec� hY�I'CE,O rc�rulalit�r�s and is crrtiticd to he o��ratin�����ithin �arcc�,tahli: p���rarneters. TYPE OF ASSE:�iBLY ❑ Rcducrd Pressure Piinci�le � Fressure Vacuimm Brcaker �`, �ouble Chxk Valve � Atmospherc'dacuum Breakc: Manufarnue: t�� Sizc 2�� Mode:'�i�bc: �d 7/�'L I LocatcdAt �'� L"or � � ���f/^�f' s����b� qSo�j 2 I REDUCED PRESSURE PRINCIPLE A,SSE1�ffiLY I PRESSURE V:�C[l'U:tit BREAKER � Double Check Valve?issembly I � Ii lst Chec1: 2nd Chec{: Reiief�alve ;1ir Inlet Cbecic Vaive i' 1 InivaI Tcsi � DC-Cins�d l,8 Closed Ti;ht �1' Opene�at Oueaai at flsid Ti�t � Lcal:cd �r y ❑ psid osid j RP- nsid i! Leai:e� C Ihd not Open " L.ea�:ed � �� � and Mataials Uscd Test ARer I}C-Closed Closod Tie,.,ht o Opcncd at Opmcd at osid Repair Tighc G osid osid RP sid The above is c.atifie�to be true. Fum Name FX'�"tL�►�1 t`1V'L i"2L�� Ccrafiod Tata n e Firm Address I,�YJ�X /-I� Cert.Tester No. �Jl��IL�S)Dau � ZD (�j L(,4�kGc d�C�C 11(,� I k i�auge # ��/��jr llate 1Hsi accuracy tested White - Customer's Capy Yellow - City Copy Pink-Tester's Copy