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Pressure Vacuum Breaker Assembly (PVB) & Spill Resistant Pressure Vacuum Breaker
Test Report
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PVB > Shutoff#2 Gate Check Valve Air Inlet Valve SRPVB - Tightness of
Valve Check Valve
Leaking ( )
Initial Test Leaking ( ) Closed Tight ( ) Failed to Open ( ) Failed to Open ( )
Pressure Drop Across
Closed Tight ( ) Check Valve#1 psid _Opened at psid psid
Any Repairs/parts
Used
Air Inlet Valve
Leaking ( )
Final Test Leaking ( ) Closed Tight (75. Opened at. ,q psid Failed to Open ( )
Pressure Drop Across (+ )
Closed Tight Ni Check Valve#1 l•°1 psid Opened at psid
Certification
I hereby certify the foregoing data to be correct and that the device Assembly Final Test Performance
tested is functionin! within the limits of the standards
Signature: / Pass
Date:
ttl\140 Fail ❑
COLE FORD Certification#066445-PM I GARY FORD Certification#058476—PM I
ALAN FARR Certification# 066481 BF
Metro Testing/Metro Mechanical Consultants,LLC 9112 Davenport Street NE,Blaine,MN 55449
612-221-5888
Plumbing Bond License:PC646918 Mechanical Bond Certificate ID:5054-MB
This report is for the purpose of recording only;Owner is responsible for safe operation and upkeep of scheduled maintenance.