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2012_0420 (7)CHECK ONI;: IRRIGATION DOMESTIC ! � FIRELINE BACKFZOW PREVENTION ASSEMBLY TEST' AND MAINTENANCE REPORT NAI�� OF PWS: � �'�' � G� F� �-- _ PWS I.D. # K� LOCATION OF SERVICE: yC�� y [ � �,.. a The backtlow prevention assembly detailed below has been tested and maintained as required by TCEQ regulations and is certified to he operating within acceptable parameters. TYPE OF ASSEMBLY � Reduced Pressure Ptznciplc C Pressure Vacutmm Breaker j�,j' Double Check Valve O Atmosphere Vacuum Breaker Mauufacturcr (A�� =t 'r' 't S Size /� � .. Model Number dy 7 ►"'� i Located At C_� ft'l �'re� o�i � _J � d � serial Ntmmber A a G G a� REDUCED PRESSURE PRINCIPLE ASSEMBLY" I PRESSURE VACUUM BRE_A�'R Double Check Valve Assembly 1st Chem: 2nd Checl: Relief Valve Air Inlet Cheek Valve Iaitial Test DC- Closed Closed Tight � Opened at Opened at nsid Tight + . �j �7 Leaked � + � a ` nsid nsid RP- nsid Le -'eked o Did not Oprn � Leak«i o Repairs and Matc-ials Used Test Af%r DC- Closed Closed Tight O Opened at Open«i at nsid Repair Tight � nsid nsid RP sid The above is certified to be true. ✓� S Firm Namc .� /C 7' in �1 � 1 C Certified Tcste IppJ/n� w� -t � � iitl G� �n vt � ` Firm Aridness PO (�L' iC % �/ % Cert. Tester No. P i0 ©c7 9�/� Date �- /�.�6 /i lit%- J� Gi 1n c � v► -c Gauge # � � � /�'/ / � . llate last accuracy tested � % / 1 White - Customer's Copy Yellow -City Copy Pink - Tester's Copy