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St Ann Catholic-LR011008
CtlECK ONE: IRRIGATION DOMESTIC BACKi~OW P ,REVENTJON ASSEMBLy T~ST AND MAINTENANCE REPORT PWS I.D. # The bacldlow prevention azs~mbly de~ilcd below has been ~ and maintained as r~quired by. TN'RCC r~.a~lafions and is certified to b~ operating v~thi, acceptable parame~r~. TYPE OF ASSEMBLY m l~duced Pr~ssur~ Principle D !~ Double Ch~ck Valve ~ M~a~ ~e~ S~ M~I N~b~ ~0C ~a~At S ialSmbcr Pressure Vacuum Breakm' Am~osphere Vacuum Break~ REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BRF_.A.I~R Double Check Valve Assembly 1st Check ] Iud Check Relief Valve Mr Inlet Check Valve Closed Tight ,~ff Opened at Opened at psid haitial Test DC-Closed Ti~ht -'q ' 2 1/ Leaked r~ gsid psid l.~ak~xt 12 Did not Ope~ r2 L~aked Mat~'ial~ T~t ~ D¢-Clo~ed Clo~l Tight cl Opm~ at 01:~1 at p~id R~air Tight ~ p~id p,id RP p~id Gauge # ~__ Date last accuracy tested White - Customer's Copy Yellow - City Copy Pink - Tester's Copy