2010_0209 (5)Feb 15 2010 2:16PM FIRE POWER SYSTEMS
CIIECK ONE:
(972)641 -5480 p.7
IRRIGATION DOMESTIC FMELINg )( b
BACTYLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: n4 o�
PWS I.D. #
LOCATION OF SERVICE: Sob FrtW@r+ Pmt �hia+I
The backflow prevention assembly detailed below has been tested and maintained as required by TCEQ
regulations and is certified to be operating urithin acceptable parameters.
TYPE OF ASSEMBLY
o Reduced Pressure Principle o Pressure Vacmtm Beaker
1K Double Check Valve o Atmosphere Vacuum Breaker
Manufacturer f.,%flf-S Size 3 /y.
Model Number 007M I d'r Located At wtsf a; 6 v;4u 14-
Serial Number S 5(,o-7
Nairre�Qe�'f kF w�tf u t 8S8 Sj 79
The above is calif ed to be true.
Firm Name Fife. Pawtr Sb sf w►s g I-vc Certified Tenor L tir►.t..J
FirmAddness 1171 Rv3ll ,-s �r-vL Cat; Tester No. z 4 Dote,.
6 ri -Ot Pr*- i ri L,7-k
Gauge # 3 7 Z .77s-
--
Date last accuracy tested / -,2 5�- %d
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
I PRESSURE VACUUM BREAKER
Double Cheek Valve Assembly
Ist Check Znd Check
Relief Valve
Air Inlet Check Valve
Initial Test
DC- Closed Closed Tight
J ( Opened at
Opened at -psid
L
Ti
--psid
.
��DSid
P� S
, 2
-- --psid
a
Did not Open o Loomed o
Repairs
and
Materials
I.Used
Test After r
DC- Closed Closed Tight
o Opened at
Opcaedat said
- -�
Repair
Tight D
�psid
nsid
RP id
The above is calif ed to be true.
Firm Name Fife. Pawtr Sb sf w►s g I-vc Certified Tenor L tir►.t..J
FirmAddness 1171 Rv3ll ,-s �r-vL Cat; Tester No. z 4 Dote,.
6 ri -Ot Pr*- i ri L,7-k
Gauge # 3 7 Z .77s-
--
Date last accuracy tested / -,2 5�- %d
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy