Coppell CC 1B1-LR010917 (6)CtlECK ONE:
IRRIGATION DOMESTIC FIRELINE' ~
s^ao ow ASS LV m' O r
NAME OF PWS:
Manufacturer
Model Number
Serial Number
R~duced Pressure Principle
Double Check Valve
TYPE OF ASSEMBLY
Siz~
Located At
Pressure Vacuum Break~
Atmosph~'~ Vacuum Breaker
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM B~R
lstD°ublecheckcheck Valve[, Assembly Rel/ef V~' ~V
~ 2nd check Air Inlet alve
Imual Te~ DC-Closed~ Closed Ti~t ~. Opened at ~' ,~e~ed at ../ r'~sid
~ Rp-Tight ~.~psid ~ L~ak~,~.O rl psid~s"---~'~PS~0
Tern A~r DC.CI"'/~ed C"l~ed Tight o Op~ Opened at psid
l~air Tight rn .~___p$id psid
RP psid
Certified T~st~r
C~t. T~ter No.
Date last accuracy tested ~.2tf- O/
White - Customer's Copy Yellow - City Copy Pink - Tester~ Copy