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Riverside Church-LR010802
CIIECK ONE: IRRIGATION DOMESTIC FIRELINE ~' BACKFLOW PREVENTION ASSEMBLY TF.~T AND MAINTENANCE REPORT NAM~ OF PW'S: PWS LD. # LOCATIONOFSERVICE:i~i'*e,g,'cJt ~'4~L, ,xp dk~-;s/'- Th~ b~k.fflow pr~v~z~fio~ ~ss,'~mbly d,m~iled below h~s beea t~'ted ~d m~,i,,,i,ed ~ z~ by. TNR.CC m~l~:ioas ~ ~s c~'zified to be ol:~z~tiag wb'hln ~':c,~pmbl¢ p~,amem's. Double Check Valve M~nuf~-mrer Iq,4 Y7'$ Siz~ Mo&I Numbe~ '7"~ ~ 0 ~, Lecat~l At Serial N~mbet OO! I ~ TYPE OF ASSEMBLY Pr=ssure Vac~-~ Br~k=r Atmosphere Vacuum REDUCED PRESSURE PKINCIPLE ASSEMBLY : PRESSURE VACUUM BREAI~ Double Check V~lVel As'~mbly% ~ 1st Check [ 2ad Check Relief ~ve .Air Inlet ImtialTest DC-Closed 3.(~ Closed Tight ~"Op~xiat ~ Ope~eda~ j _..____..t~d Ti/hr //f Leaked ~2 psid ~.~, VI RP- psid 3, 2.. L~ked ~ Didn~D~ r~ ~ m l~air Tight ~ .id p~id RP.~__._p$id C~/fi~i Cet~ T~ster No. 2P'(4 I eddeli Date last accuracy tested White - Customer's Copy Yellow - City Copy Pink - Testedas Copy