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MacPlaza 1 City-LR 961016
CtIECK ONE: IRRI~ATION DOMESTIC FIREI,INE BACKI~OW PREVENTION ASSF, M~LY TEST AND MAINTENANCE REPORT ~A~ O~ PW$: ~ ~'-fY ~,~ff- PWS I.D. # LOCATION OF SERVICE: The b~ow p~mfion ~s~bly de~ below ~o~ ~d ~ ~ w ~ op~g ~thl. ~ble Manufacv. r~ Mo&l N-tuber Scrim Number l:Leduc~ Pressure: Principle Double Ch~ck Valve TYPE OF ASSEMBLY a Pr~ssur~ Vacuum Br~k~ ~2 A~mosph~r~ Vacuum B~ S~ /// REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER Double Check Valve Assembly 1st Check [ 2nd Check ,l~.lief Valve A/r Inlet Check Valve ImUal T~st DC-Closed /Closed Tight ~ Open~ at Opened al psid Tight ~/ Leaked o psid psid R.P- psid ~ a Did not Open o Leaked ~ and Materials Used T~st Ai~ DC-Closed Closed Tight n 0pcned at 0p~d at psid Rrpair Tight o psid psid RP psid Cm't. Gauge # .A,//)~,~ /t_)~77~ /---"/~)f Date last accuracy tested ~Q - ~ -- ~> White - Customer's Copy Yellow - City Copy Pink - Tester's Copy CtIECK ONE: DOMESTIC FIRELINE BACKFLOW PREVENTION ASSEMBLY TEST AN]) MAINTE CE REPORT PWS I.D. # LOCATION OF SERVICE: ~z>// ~. ~f/Y~Y'~7"'/vq.Y~ 'l-ne b~ow p~fion ~s~bly der~H~ b~ow h~ ~ ~ ~d m~{.r~i.~ ~ ~ ~ ~CC ~o~ ~d ~ ~ to ~ op~g ~rh~- ~e~le p~. TYPE OF ASSEMBLY Manufacturer Model Number S~vial Nm'nb~r Reduced Pr~ssu~ Prm~ple Double Ch~ck Valve Pressuru Vacuum Breaker Aumosph~r~ Vacuum Breaker REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER Double Check Valve Assembly ls~ Check [ 2nd Check l~}ief Valve Air Inlet Check Valve Imtial Test DC-Closed /Closed Tight ~ Opened at Opened at psid Tight ~/ Lm{ked m psid psid RP- psid Leaked ~ Did uot Open m l.~aked m aud MateriaLs Used ,, T~st ~ DC-Closed Closed Tight m Opted at O~ at psid Repair Tight u psid .psid RP psid Firm N,m~ '7-',~ ~ V~--~ C~fifi~d Te~t= // Date ,o.qt accuracy tested White - Customer's Copy Yellow - City Copy Pink - Tester's Copy CIIECK ONE: IRRIGATION DOMESTIC FIRELINE / BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: PWS I.D. # LOCATION OF SERVICE: ~'// ~, /~///~/~/.~ The bacidlow prevention ass~nbly ~ ~low ~ ~ ~ ~d ~.~.,.i~ ~ ~ ~ ~CC ~o~ ~d ~ ~ to ~ op~g ~thln ~c~ble p~. TYPE OF ASSEMBLY , Reduced Pressure Prmcipl~ r~ Double Check Valve [] Meaufactur~r ~ ~ Size modelN-mber -~d~)~ ,~)~'~Z~)/~- LocatedAt Pressure Vacuum Br~alm' Atmospher~ Vacuum Br~alm' REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER Double Check Valve Assembly Is~ Check [ 2nd Check /~, ,,.llef Valve Air Inlet Check Valve Imtial T~st DC-Clos~ , Closed Tight 9/ Opted at Opened at psid Ti_~ht s~' L~k~d ~ psid psid PP- psid Leaked ~ Did not Open c:l Leaked ~ and Materials Used , Test Alter DC-Closed Closed Tight c~ Opened at Opened at psid R~air Tight cl psid psid RP p$id The above is certified to be true. Firm Name ~ Gauge # Z~~_~-/~ Date last accuracy tested White - Customer's Copy Yenow - City Copy Pink - Tester's Copy CHECK ONE: IRRIGATION DOMESTIC FIREI.INE ~ BACKFLOW PREVENTION ASSEMBLY TEST AND ~CE REPORT PWS I.D. # LOC^nO~ O~ S~V~CS: ~// ,%v, ./77~ ~ b~ow p~fion ~s~bly d~ b~low ~ ~ ~ ~ ~i.t~i.~ ~ ~ ~ ~CC m~om ~d ~ ~ m be op~g ~thl. ~bl~ p~o,.~. ,, ,/R~uc~d Pressure Pr/nc/pie Double Ch~:k Valve Manuficturcr Mod~l N~tmbc-r Serial N,~b~r (',z3 7 ~//'/- TYPE OF ASSEMBLY g Pr~r~ Vacuum Brrmk= [] Am~osph~r~ Vaco,rm Bm~ S~ ~/~// REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER Double Check Valve Assembly Ist Check J 2nd Check Relief Valve Air Inlet Che~k Valve Imual T~st DC-Clos~ ~Clos~d Tight ~ Op~ned at Op~n~l ~t psid Ti_~ht ~ L~k~ ~ psid psid KP - psid Ixak~d C~ Did not Op~ ~ I.~k~l fl i Mamrials Used T~st Aft= DC-Closet Clos~d Tight u Op~n~ at ~ ~t psid R~pair Tight m psid psid RP psid / Firm N~ar~ ~ .~,,.=~//I~.f' C~ified Test= Date last accuracy tested White - Customer's Copy Yellow - City Copy Pink - TestePs Copy