2012_1130 (5)CiIECK ONEc
IRRYGATION�_ DOMESTIC � FIRELINE
BACKPZOW PREVENTION ASSEMBLY TEST RNLI MAITTI'ENANCE REPORT
NAME OF PWS: G- + ? `� L'' � LC�,��r_ //
PWS I.D. #
LOCATION OF SERVICE: 600 Freeport /Duke - Freeport IX
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 LY
Reduced Pressure Principle Pressure Va�-*n*m Breaker
e Double Check Valve Atmosphere Vacuum Breaker
MaIIUfacturer atts S17P 2
�.
Model Dumber 007M 1 Located At SW corner of property @meter
Serial Number 95832
The above is certified to be true. ��/p ����
Firm Namc Action Fire Pros Certified Tester Allen Stevens ��!!i'! � - %'' L�
PO Box 797 Waxahachie BP0009860 11 -30 -12
Film Address Cart Tester No. Date
4iauge # 07090476
Date Iasi accuracy tested 9-21 -12
White - Customer"s Copy Yellow -City Copy Pink - Tester's Copy
REDUCED PRESSURE PRINCIPLE A.SSEI4IBL'Y
1 PRESSURE VACUUM $KF'4�'R
Double Chec4c Valve Assembly
Ist Chec3:
2nd Checi:.
Relief Valve
Air Illlei
Check Valve
Initial Test
DC- Closed
Closed Tight
Opened at
Opened at
t►sid
�/
�
Tight a, oZ
Leaked
nsid
osid
��
j7�`
RP- DS3
Leaked
°� r ®
Did aot Open D
Leaked o
Repairs
aad
Materials
used
Test Afies
DC- Closed
Closed Tight o
Opened at
Opined at
nsid
Repair
Tig}lt Q
DSld
vsid
RP sid
The above is certified to be true. ��/p ����
Firm Namc Action Fire Pros Certified Tester Allen Stevens ��!!i'! � - %'' L�
PO Box 797 Waxahachie BP0009860 11 -30 -12
Film Address Cart Tester No. Date
4iauge # 07090476
Date Iasi accuracy tested 9-21 -12
White - Customer"s Copy Yellow -City Copy Pink - Tester's Copy