2012_1130 (4)CIIRCIi CDNE:
IRIiICATIiJN�,_ DO1I+IESTIC � FIRELINE � V J _
BACKFL0�7 PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: �- r ? `/ G'' F- ��,��� i1
PWS I.D. �
LOCATION OF SERVICE: 600 Freeport /Duke - Freeport IX
The backflow prevention assembly detailed below has been. tested anal maintained as required by TCEC�
regulations and is certified to be operating within acceptable parameters.
TYPE OF LY'
eReduced Pressure Principle Pressure Vacuum Breaker
�/ Double Check Valve Atmosphere Vacuum Breaker
Manufacturer Watts Size 3/4"
Model Number 007M 1
Scial Number 49366
Located At
SW corner of building in vault
The above is certi5ed to be true.
Firm Namc Action Fire Pros Coed .L�� Allen Stevens
PO Box 797 Waxahachie BP0009860 1 1 -30 -12
Firm Address � Cert Tester Na_ Date
C:auge � 07090476
L7ate last accuracy tested 9-21 -12
White - Customer's Copy Yellow -City Copy Pink - Tester's Copy
PRESSURE VACLJ'L.TM BRFAKF'R
REDUCED PRESSURE PRINCIPLE ASSE:LLBLY
Double Check Valve Assembly
Relief Valve
Air Inlet
Check Valve
1st Check
Zed ChecI:
al Test
� ss�
DC- Closed
Tighht a, y
�- nsi
Lcal:ecl
Closed Tight
Leaked
a , �.
Opened at
psid
Opened at
nsid
Did not Open O
nsid
Leaked O
Repairs
and
Materiais
used
Test ARcr
Repair
DC- Closed
Tight a
Ciosed Tis,,,ht C]
C)pened az
nsid
Opened at
nsid
nsid
RP sid
The above is certi5ed to be true.
Firm Namc Action Fire Pros Coed .L�� Allen Stevens
PO Box 797 Waxahachie BP0009860 1 1 -30 -12
Firm Address � Cert Tester Na_ Date
C:auge � 07090476
L7ate last accuracy tested 9-21 -12
White - Customer's Copy Yellow -City Copy Pink - Tester's Copy