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PA9901-LR021104CtlECK ONE~ IRRIGATION DOMESTIC BACIOI~W pREVENTION A~F.~LY ~ AND ~C~ Ii, PORT NAM~ OF PW$: TY~E OF ASSEIV~LY Sb.e I.~cat~l At P~sm~ Vacumn Bm.~k~t 'Aunosph~ Vacuum B~ REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER Doubl~ Check Valve IstCbeck ..~./~ 2ndChaek.dl.~ iblietV~lve AirlnJ,et CheckVaIve, Ti$1u ~''L~k~l I~P- ,, Ma~ Us~ ....... T~t ~ DC-~Ios~ Cl~ Ti~ ~ ~m~ a~ ~ at ~d ~ , psid C~'t T~ No~~ Da"- ~~' Oau&e # ,,,.~.O/aq*'/f Date last accuracy tested White - Customer's C~nv Yallnw - ~{tv f~.n~u ~1,,1~. ?~,+.~ r,^,,,, 03/24/2003 10:50 9727235308 CIRCLE H PAGE 03 CtlECK ONE: IRRIGATION DOMESTIC FIRRLINE X Pressure Vacuum Breakar Am~osph~r¢ Vacuum Bre~' Th~ above is cgrfifl~i to be ~'u~. _Dam Date last accuracy tested Cill/CK ONE: IRRIOATION DOMESTIC FIP,.IglANE BACKFLOW PREVENTION A,~$F, MIILY ~ AND MAINTENANCE REPORT NAM]~ OF PW$: PW$ I.D. # - ~ ~ ~ ~ to b~ op~g ~ ~bl~ p~. TYPE OF ASSEMBLY Double Ch~k Valve r~ Mod~l Number ~. ~ll ~}'"r- Located At Pr~ssur~ Vaotmm Bnmkm' Am~osphcre Vacuum Breaker REDUCED PRESSURE pRINCIPLE ASSEMBLY PRESSURE VACUUIVl BRE~R Double Check Valve Assembly hiual T~s~ ! DC-Closed ,.,Glosed Ti~t l:~~:~ at Opmeci at psid and T~,st Afl~ DC-Closed Closed Ti~t [] Opted at Opm~i at ~ psid P,~air Tight ~ psid _ osid Date last accuracy tested 18:58 9727235308 CIRCLE H ~ PAG£ CHECK IRRIGATION _ DOME3TIC ,~/ FIRELI~E BACKFLOW PREVENTION A3SEM~LY TEST AND MA/NTF.,iq~JgCE REPORT NAM~ OF PWS: REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER Double Check Valve Assembly l~tCbeck if~ 3ndCheck [.~. R~efVnlve Airlniet CheckValve I, ni~ial Te~ DC-Closed ~los~[ Tight ~'~ ~"OP~ed at Op~n~ at .__.._._.psld Ti~t ~' L~c~i a psid .mid RP- psid ~,~ Leakni ~ Did not Op~ ~ Leaked and Matrrials Used T~t ~ DC-Clos~l Closed Tight 0 Opm~ at Op,n,~d at psid P~air Tight ~ p$id psid RP psid ~. Date last accuracy tested