2010_0209 (7)Feb 15 2010 2:16PM FIRE POWER SYSTEMS (972)641 -5480 p.3
CHECK ONE:
IRRIGATION
DOPAEM7C
FIRELINE )< Q
t_ BACIO.LOW PREVENTION ASSEMLY TEST AND ]I CE REPORT
NAME OF PWS: C.�` o CO ADO. t
PWS 11). #
LOCATION OF,SERVICE: O Frtt cr-r �f
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
C Reduced. Pressure Principle ❑ Pressure Vacuum Breaker
fit( Double Check Valve ❑ Atmosphara Vacnuun Breaker
Manufacturer Size /� • ,
Model Number 00-7 2 Q Located At No rl'� a � �•• � i r.,. � � p � • L
Serial Number Uwk.1 -1e- +e f t*A za (e 3S) Z �'^� ur►� i�
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER
Double Check Valve Assembly
J 1st Check I 2nd Check I Relief valve 1 Air
IaiUal Test DC- Closed Closed Tight A� Opened at
Tir,,,ht m( Leaked o �Tnsid
RP- JL,sid
Leaked 0 2 C1
Repairs
and
Materials
Used
Test After DC- Closed
Repair Tight
RP
The above is certified to be true.
Opened at
_,psid
Check.
Did not Open ❑ ' Leered
G Closed Tight O Op 3t Opened te d sid
T mName `ir4- pwar sUffiws
Finn Address -11'71 l2e .s
C°ar" (7X 7SGra
Gauge 37 7- 7 7
Date Iest accuracy tested /- Zs" Q
Certified Tester A s�er S��►�ta
Cent Tester No. 19200 28 Z S-k Date 0
- .d
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy
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