2012_1130Citl'sCli ONE: �-��
IRRIGATION_ DOMESTIC � FIRELYNE IN I
BACKFLIpW PREVENTION A5SEI��LY TEST AND NiA.INTENANC7r REPORT
NAME OF PWS: L + "7 �� L''' F !�c_',� C� `°
PWS I.D. �
LOCATION OF SERVICE: 600 Freeport /Duke - Freeport IX
The backflow prca�ention assembly detailed below has been tested and maintained as required by TCEQ
regulations and is certit�ed to be operating within <zcceptable parameters.
TYPE OF LY
Reduced Pressure Principle Pressure Vacuzmz Breaker
�/ Double Check Valve Atmosphere Vacuum Breaker
Manufacturer attS Sizc 8
�.
Modellvumber 774DCDA Located At NW corner of building in vault
Serial Number 1001 17 0301
The above is certified io be true.
Firm Name Action Fire Pros Certified Tester Allen Steven -�-
PO Box 797 Waxahachie BP0009860 1 1 -30 -12
Firm Address __ - __ -- Ccrt. Tester No. Date
Gauge # 07090476
Date Iasi accuracy tested 9-21 -12
Mute - Customer's copy Yellow -city copy Pink - Tester's Copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VaCUerI�I SRF'AItF'It
Double Check Valoe Assembly
1st Check
tad Chec3:
Relief Valve
air Inlet
Check Valve
Iaitial Tcst
DC- Closed
Closed Ti�itt �
Opened at
Opened at
osid
S�j�9�
Tight 3�,•�
RP- nsi
Leaked
Leaked
°� � �
osid
osid
Did not Opea o
Leaked Q
Repairs
and
Materials
IJscd
Test After
DC- Closed
Closed Tight a
Opeacd at
Opened at
osid
Repair
Ti�ltt Q
osid
nsid
RP std
The above is certified io be true.
Firm Name Action Fire Pros Certified Tester Allen Steven -�-
PO Box 797 Waxahachie BP0009860 1 1 -30 -12
Firm Address __ - __ -- Ccrt. Tester No. Date
Gauge # 07090476
Date Iasi accuracy tested 9-21 -12
Mute - Customer's copy Yellow -city copy Pink - Tester's Copy