2012_0326- - - -- - -- � - - .....�.s,r..._....., i i co i tstrL mAllV�CE.t`LANCE REPOAT
NAME OF PWS: � � � �t�Z- �_
PWS I.D. T
LOCATION OF SERVICE: �^-► � � �� � � 1 �
The backflow prevention assembly detailed below has been tested and maintained as required by TCEQ
ree lations and is certifed to be operating within acceptable parameters.
TYPE OF ASSEIIABLY
C �.Beducrd Pressise Principle C Presszaa Vacus� $2dk�-
O�� Double Qaec3: Valve C Amsosphere Vacuum $reaicr
Maaufacuaer � - e�J("U Size � /"/ % i
Medal I`iu=aber � S `� Located At _ � �N/��- �:- W
Serial Nuazber "� L�2 � �,
Iaitial Test
��
�F�
aad
Materials_
Vsed
Tit A1ic
R.cparr
REDUCED PRESSURE PRINCIPLE ASSEIl�LY
Do�xble Giiee3t Valve Assembly
1st C1aer3: .2nd Cher.[c R ^7; i%alve
DC- Closed Closed Tight ed
Ti�tt '�.; �-( Leaked D id
p� -SSUI� YACIJ7JiHr $RFA T('F"R
at
DC- CIosed Closed Tight o Qpm� at Op�ad at
Tigtit� O acid .�,_,flsid --- --nsid
itP�sid .
Tile about is cctified -to be tom,
Fsrm Nano ��C� S� -�..� } Ca-cfiad TestQ �.ln , ,.. 1
f
Firm Rddrtss -.. ; � L f ``' ,� .P �-�-� in 76 _- .-,,
� �-- 3= �5-� "r :� ...�a -x,_ estrs7�lo.� � (�"� �a�'I Date a'" -�
Gauge � � t. �-Lt -t 2 d � -
Date last accuracy tested �± � t � - � e
- - 6 ,
f1'11Ite - GUS20i72ErJS Copy Yellow - Ci Co
� I?Y Pink - Tester's Copy