2012_1130 (3)CIIL'CK UNE:
iRRIGATION_�_ DOMESTIC � FIRELINE
BACii�LOW PREVENTIf3N ASSEMBLY 'TEST AND MAINTENANCE REPORT
NAME OF PWS: �- / `� �� G" h C c�'��1 r /1
PWS I.D. #
LOCATION OF SERVICE: 600 Freeport /Duke - Freeport IX
The backflow prevention assenxbly detailed beloti�- has been tested and maintained as required by TCEQ
regulations and is certified to be operating within acceptable parameters.
TYPE OF LY
Rrduced Pressure Principle Pressure Vag-* ^***+ Breakez
B✓ Double Cheek Valve Atmosphere Vacuum Breaker
Manufacrczrer alts Stu 8
��
Model I'Slmmber 774 D C DA
5eriai Number 10021 O 0330
Located At
SW corner of building in vault
The above is cezti.fiexl zo be true_
Firm Names Action Fire Pros Certified .r�� Allen Stevens
Firm Address PO Box 797 Waxahachie Cent Tester No BP0009860 Date 1 1 -30 -12
Gauge # 07090476
Date last accuracy t�esteci 9-21 -12
White - Customer's Copy Y Bellow —City Copy Pink — Tester's Copy
REDUCED PRESSURE PRiNCTPLE ASSEMBLY
PRESSURE vACUiJM B72�'A�'R
Double Check Valve Assembly
Ist Check
Zad G71eci:
Relief Valve
Air Inlet
Check Valve
Initial Test
DC- Closed
Closed Tight
Opened at
Opened at
acid
�,/
�jSS�y
Tight a, $
�P DSI
Lcal:ed
Leaked
� � �
psid
osid
Did not Open O
Leaked O
Rcp airs
and
Materials
Used
Test After
DC- Closed
Closed Tight o
GTpened at
Opened at
osid
Repair
Tight Q
osid
asid
RP snd
The above is cezti.fiexl zo be true_
Firm Names Action Fire Pros Certified .r�� Allen Stevens
Firm Address PO Box 797 Waxahachie Cent Tester No BP0009860 Date 1 1 -30 -12
Gauge # 07090476
Date last accuracy t�esteci 9-21 -12
White - Customer's Copy Y Bellow —City Copy Pink — Tester's Copy