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Pressure Vacuum Breaker Assembly (PVB) & Spill Resistant Pressure Vacuum Breaker <br /> Test Report t <br /> 13nsin0:,: i.'<1111:,ct i'tr>;efn/7 nl.: ll:rSr: <br /> ,fth <br /> �3-9-g <br /> 1 as res.s: Ci tp: Ail): <br /> 7 7C) &oh1i40111,22g_ Oftflt <br /> x)14)//645 <br /> 14) / 4 5 'tlrnlrl: 7001-1 Sirr:I ii `tcr..,! r -05 LC5J <br /> I.uct,tion of 1)tr'icc: Si f Nfirerdir <br /> t r1,.,hat'*•.--teen: t <br /> �Aghf l(. o. Ao'iw t'alibratti/rn 1l;t:c: flat(of'1f SI' t1,n'ui psi: ii:f.U,i'l'rpssnrc; <br /> PVB - > Shutoff#2 Gate Check Valve Air Inlet Valve SRPVB -Tightness of <br /> Valve Check Valve <br /> Leaking O <br /> Initial Test Leaking ( ) Closed Tight$1) Failed to Open ( ) Failed to Open ( ) <br /> Pressure Drop Across <br /> Closed Tight) Check Valve#1 psid Opened at—psid _psid <br /> Any Repairs/parts <br /> Used _ l <br /> l JGl b 5-k Air Inlet Valve <br /> Leaking( ) <br /> Final Test Leaking ( ) Closed Tight( ) Opened at psid Failed to Open ( ) <br /> Pressure Drop Across ( ) , <br /> Closed Tight( ) Check Valve#1 _psid Opened at psid <br /> Certification <br /> I hereby certify the foregoing data to be correct and that the device <br /> Assembly Final Test Performance <br /> tested is functioning withi the limits of the standards <br /> Signature: 4'y e fite0 <br /> Pass <br /> Date: -(;_) Fail ❑ <br /> : �7� 7 <br /> Royce Roberts Certification #PM063607 <br /> Gary Pegues Cerification #PM064908 <br /> Sabre Plumbing Heating and NC <br /> 15535 Medina Road, Plymouth, MN 55447 <br /> 763-473-2267 <br /> Plumbing Bond License: PM645349 <br />