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2011_1017 (6)
CHECK ONE: IRRIGATION DOMESTIC FIRELINE BACTMOW PREVENTION ASSEIVI$LY TEST AND MAWMANCE REPORT NAME OF PWS: e.�P� PWS LD. ;# LOCATION OF SERVICE: 17 The backflow prevention assembly detailed below has been tested and maintained as required by TCEQ regulations and is certified to be operating within acceptable parameters. ❑ / Reduced Pressure Principle Double Check Valve Manufacturer Model Number 7a y Serial Number TYPE OF ASSEMBLY ❑ Pressure Vacuum Breaker E3 Atmosphere Vacuum Breaker Size 9- Located At VAIt - SE c.." p4l p--�e The above is certified to be true. Fimn Naste _ ACT1_01V Au=o- _ 5-r-13 CereiBed Tester Firm Ad&= ,Pie r3 r � 7 q-7 Cat Tester No. EPOID 6-1-52 Date J 0�''„?,_% 1 WAtc, —11L "75)6$ Gauge # Date last accuracy tested White - Customer's Copy Yellow - v ty Copy Pink - Tester's Copy i REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1st Check 3' 2nd Check 3, © DC- Closed Tight Closed Tight Leaked ❑ OpenedAt sid Opened at osid nsid Initial Test RP __psid Leaked C3 DidnotOpen ❑ Leaked C3 Repairs and ' Mate+iats Used Test After Repair DC- Closed Tight RP sid Closed Tight ❑ Opened at _____p sid Opened at nsid _______psid The above is certified to be true. Fimn Naste _ ACT1_01V Au=o- _ 5-r-13 CereiBed Tester Firm Ad&= ,Pie r3 r � 7 q-7 Cat Tester No. EPOID 6-1-52 Date J 0�''„?,_% 1 WAtc, —11L "75)6$ Gauge # Date last accuracy tested White - Customer's Copy Yellow - v ty Copy Pink - Tester's Copy i