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2012_0718 (2)CIIECK ONE: IRRIGATION DOMES'TiC PIRELINE BACKFLOW PRlEVENTION ASSEl►�LY TESTi' AND /� CE REPORT NAME OF PWS: l< <, I l/ C� � �i�I> C�-) � � 1 i.Q S. (�'�7 —P C_I � � �� ,TIC PWS LD. # - � S � f LOCATION OF SERVICE: P�x-,� �' Clma h �.t o� ��b %% %LYZ�s-y�c��P �� 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 � I2edll[xd PieSSiIre PrmciplC � Pressure Va[ -+n�� BiCd�CS �t. Double Check Valve � Atmosphere Va�-*n•*•+ BTM�L� Manufactc�er i,� ,- f _I� � _ Y�7 S Size � ��- Model Nimmber cIS O X�T - [�, Located At �1 . �e.�-c�s, -,-, `�� u��,4Q.yIPo .ys- ywvm� -v h Serial Number 1 /.� � � S U- � O The above is certified to be true. Wrlgpt Beckttow 8 PLBG ` Fum Name Certified Testa � oc{ n e .� � it r . � r-7,'� Firm Address �� Cert. TesterNo.L�� ©�OU�7SOD� '7 -� � -/Z Gauge � 13 'g � z 3 \.�l �'e � -k-s T K - 9 � LC Date last accuracy tested] White - Customer *s Copy Yellow -City Copy Pink - Tester's Copy REDIICED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACiJLTM BRFSSCF'R Double Cheek Valve Assembly 1st Check 2nd Check Relief Valve Air Inlet Check Valve Initial Test DC- Closed Closed Tight Opened at Opened at � d � S TishL Leaked O acid __osi_d � RP- �. °' osid Leaked a z- Z Did not Open D i r�i..�t p �P�� and Materials Used Test ABer DC- Closed Closed Tight o Opened at Opined at nsid Repair Tight o osid osid ItP sid The above is certified to be true. Wrlgpt Beckttow 8 PLBG ` Fum Name Certified Testa � oc{ n e .� � it r . � r-7,'� Firm Address �� Cert. TesterNo.L�� ©�OU�7SOD� '7 -� � -/Z Gauge � 13 'g � z 3 \.�l �'e � -k-s T K - 9 � LC Date last accuracy tested] White - Customer *s Copy Yellow -City Copy Pink - Tester's Copy