2010_0209 (6)Feb 15 2010 2:17PM FIRE POWER SYSTEMS (972)641 -5480 P.8
CFLECK ONE:
IRRIGATION DOMESTIC.
FIRELINE
BACKPLOW PREVENTION ASSEMBLY TEST AND ALAEV17NMICE REPORT
NAME OF PWS:
PWS I.D. 4
LOCATION OF SERVICE. SOO F tt-p -r {
The backflow prevention assembly detailed below has been tested and maintained as required by TCEQ
regulations and is certified to be operating within acceptable parameters.
TYPE OF ASSEMBLY
0 Reduced Pressure Principle o Press:= Va== Breakw
Double Check Valve o Atmosphere Vacaun Breaker
Manufacturer t./ItffS sire g `
Model Number I TY X A e- A A Locatod At Wis F e � ��� 1'� "' "i i�v au 14-
Serial Number I(�OS471LO2 Nt.+tr Frc4.r+ of mdkr. * 1859.191 71
The above is catified to be true.
Firm Name i,a P*6jtr S!ji4ms jt-t
Firm Address l71 &jlcs
GfA,A exhl't IT.0 Wbvo
Gauge # 17 27 7 S-
- Date last accuracy tested
Certified Tats —NO-7 S'''�= Y�,trM,�.✓
Cart. Tester No. U00692-5,6 Dace .2 - /O
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VACUUM MAI=
Double Check Valve Assembly
ist Check 2nd Check
Raei Valve
Air Inlet Check Valve
Initial Test
DC -Closed Closed Tight
Tight Leaked
ld Opeaed at
Opened at --.Psid
pis
RP--L,
osid
_ —nsid
Leaked o
Did not Open O Leaked 0
Repairs
and
Materials
Used
Tcst After
DC- Closed Closed Tight
o Opened at
C
Opened at �a
Repair
Tight 0
, --paid
sid
R.P aid
,
The above is catified to be true.
Firm Name i,a P*6jtr S!ji4ms jt-t
Firm Address l71 &jlcs
GfA,A exhl't IT.0 Wbvo
Gauge # 17 27 7 S-
- Date last accuracy tested
Certified Tats —NO-7 S'''�= Y�,trM,�.✓
Cart. Tester No. U00692-5,6 Dace .2 - /O
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy