St Ann Catholic-LR011005 (2)CtlECK ONE:
IRRIGATION
DOMESTIC FIRELINE ~
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINr~<NANCE REPORT
PW$ I.D. #
The backflow prevent/on assembly detailed below l:~ b~ ~ and m~{.,~i.~ as r~cluir~ ~' TNKCC
r~_m~lalions and is c~ifi~xt to b~ operating wi*bin acca"pr~ble plu'am~uws.
....l~du~ Pressure Principle
Double Chc~k Valve
S~ Number
Manufacturer
Model Number
TYPE OF ASSEMBLY
Prcssore Vacuum Break~
A~nosphere Vacuum Bre 'al~r
Located At [~)O L:~"~ I) [t
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VAC'7.FU'M BREAKER
Double Check Valve Assembly
Ist Check [ 2nd Check Relief Valve .Mr Inlet Check Valve
)' ~ed at Opened at psid
Initial T~st DC-Clos~i CJ~iTight
Tight ~'~eaked ~ .psid psid
~ R.¢- p~id
~ [] Did not Opm r2 I.~ak~t ~
Matnrial~
U~d
T~: ~ DC-Clo~ed Clo~d Tight cI Opted at Op~med at p~id
R~air Tight m p~id prod
RP p~id
The above is cea-filled to be true.
O te tested
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy