St Ann Catholic-LR011005BACKFLOW PREVENTION ASSEWfBLY TEST AND MAI1Ni-s:NANCE REPORT
Manufacturer
Mod~l Number
S=h~/Number
~,~d~uUC~ Pr~ssur~ Princ/pl¢
bio Ch~ck Valve
qq tqd7
TYPE OF ASSEMBLY
~ Pressure Vacuum Br~k~
m A~mosph== Vacuum Br=ak=
Siz= -~A~
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACULrM BREAKER
Double Check Valve Assembly
1st Check 2nd Check Relief Valve , .Air Inlet C~'~ Valve
Inkial Te~t DC-Closed ~ Tight ~- ~ed at Opened at psid
Tight ~ "Le~k~l ~2 psid psid
· Leaked c~ D/d not Op~ m L~k=d u
Mat=ials
Used
Test Aft= DC-Closed Clos~ Tight o Opea~l at Ol~m~l at paid
Rrpair Tight cl ___.___paid paid
RP paid
The above is cerl~ed to be true.
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy