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Freeport NIP(7.1)-LR001016
CHECK ONB: IRRIGATION / DOMILqTIC F/RELDIE BACI/FLOW PREVENTION ASSEMBLY ~ AND MAINTENANCE REPORT PWS LD. # OCA O O S V C -: GO I lq. Manufacturer ~_.~'~C t'h $iz~ TYPE OF ASSEMBLY P.~duced Pmssur~ lh'inciple a Pr~ssur~ Vacman Double Check Valve ~ Almosplm~ Vacm~m B~aker Serial Number REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER Double Check V~e ~hly 1~ ~e~ lnd ~e~ ~V~e ~r I~ ~ VMve Ti~ ~ ~ o psid p~d ~ o ~d not ~ a ~ ~ M~ U~ :~ Ti~ O psid ~sfl CcrcTcs~No.~Da~ I~-[~-~ Gauge # Date last a¢curac~ tested Wldte - CestomePs Copy Yellow - Cit~ Copy Pink - Testers Copy