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Coppell CC 1B1-LR010917
CHECK ONE: IRRIGATION DOMESTIC FIRELINE ~__ NAME OF PWS: PWS I.D. # LOCATION OF SERVICE: TYPE OF ASS]~BLY Prcssu~ Vacu~n Atmosphc~ Vacuum Bz'cai~ REDUCED PRESSURE PRINCIPLE ASSEM~BLY PRESSURE VACUUM BREAKER Double Check Valve Aspmhly Ist Check 2nd Check Relief~e Air Inlet ve ~,~ F.P- psid Lcak~l c: Didnott~en o Leaked Test AI~- X'- ,4~osed T~I~ R~air Ti~t~ = psid 1~o psid Cmified Tes~ .'"~"~' ~'~ C~L Test~ No. ~°~' ~/ Date l~st accuracy tested White - Customer's Copy Yellow - City ~y Pink - Tester*s Copy