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Town Center BP-LR010921
CtlECK ONLY: IRRIGATION DOME~rIC FIRELINE BACKFLOW PREVENTION A.~'EI~LY TEb~ AND MAINI-i~ANCE KEPORT NAME OF P~: PWS I.D. ~ LOCA~ON OF S~CE: ~r~ ~ ~ Manufacturer Model Number Double Check Valve TYPE OF ASSEMBLY Pmssur~ Vac~. Br~Im' t2 Atmosph~'~ Vacuum Br~,.' REDUCED PRESSURE PRINCLFLE ASSEMBLY PRESSURE VACUUM BREAKER Double Check Valve Assembly 1~ Check 2nd Check Relief Valve Air Inlet Check Valve Initial Test DC-Closed ,Closed Tight ~ ~p~dat Opeaed at Tigh~ 2,0 ,os~ ~,' I~aked o~' ,psid PP- psid / Leaked ~: /,¥ p~ £p Did not Open Mathlab ,,~ 7~..s Us~ T~st ~ DC-Closed Closed Tight 0 Op~cd.,~'"' Opted at ~.~.psid Repair Ti~h~ aj~/_____~sid psid RP psid Cm"L Testm'No. q-~/,,Z~' 85"~ D.~,~- White - Custome~ Copy Yellow - City Copy Pink - TestePs Copy CtlECK ONE: IgRIGATION DOM~C FIRF. LINE / BACKI~.,OW PREVENTION A.SSEM~LY ~ AND MAINi'~C~ REPORT NAME OF PWS: PWS LD. # LOCATION OF SERVICE: Manufactmm' Modd Number Serial Number l~l,_,ced_ l~ssur~ ]h'incipl= Double Check Va]ye 7 7e-x' z:, TYPE OF ASSEMBLY [] ~ Vac, mm Br~k~r Aunosphcre Vacuum Brcakm- OD/77 REDUCED PRE55LrRE PRINCIPLE A~$EM~LY PRESSURE VACUUM BREAKER Double Check Valve Assembly Is~ Check !ad Check Relief Valve ~ Air hdet Check Valve I~ifial Test DC.Closed ps'P,, Closed Tight ~/ '~at Ope~d at ~ Ti/hr .,,Z,~-"Ef Leaked o ~.p,?d psid 1~- psid j,,/,, ~rP~ ' ~aked ~ ~ C3 ' ,~d not Open ,~ M=v. mals The above is cch/fled to be ~'ue. Fire Address/If3 q ,F_,~,'~ 7-r Cert T~sm'No. ~/~Z ~85'?Dam c~-~./- ol Gau~e # Date lest accuracy tested ~ -/~ ' t~ / White - Customer~ Copy Yellow - Cit~ Copy Pink - Tester~ Copy CHECK ONE: IRRIGATION DOMESTIC FIRELINE liACI4~_,OW PREVENTION ASSEMBLY TEST AND MAINTENAN~ REPORT NAME OF PWS: PWS LD. # LOCATION OF SERVICE: rc~lat~ons and is ce~fied to be opm'a6ng P,~uced I~ss'ur~ Principle Double Check Valve TYPE OF ASSEMBLY m Pressure Vacumn Breal~r [] An=ospher~ Vacuum /fz" Located At REDUCED PRESSURE PRINCIPLE ASSE]~IBLY PRESSURE VACUUM BREAKER Double Check Valve Assembly 1st Cheak 2nd Check Relief Valve Air Inlet Check Vnlve Inil~nl Test DC-Closed Closed Tight = '~tedat Opened at Ti~t [] Leak~ c~_~~' psid RP- psid ~ 0 Did not Ope~ Used ,,,, Test Aflfl- DC-Closed Closed Tight m OpenOpened.~ Opened at .~...~sid Tight a~,,~__.~psid psid Cer~ Test=No. ~W.l~2q~"~ Dam White - Customer~ Copy Yellow - City Copy Pink - Testers Copy