2012_1130 (6)C3iECK ONE_
IRRIGIITION�, DOMESTIC � BIREI.INE
BACKFLOW PREVENTION ASSEMBLY TEST ANl9 MAINTENANCE REPORT
NAME OF PWS: L I .T �� G' � c�c 1=% t7 r �
PWS I.D. #
600 Freeport /Duke - Freeport IX
LOCATION OF SERVICE: - - ._ _
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
Rtsiuced Pressure Principle Pressure Vacuum Breaker
Double Check Valve Atmosphere Vacuum Breaker
Manufacttser attS SiLC. 2
�.
Model Number 007M 1
Se~ial Number 96595
Located At
SW corner of property @meter
The above is certified io be true.
Firm Name Action Fire Pros
Firm Address PO Box 797 Waxahachie
Gauge # 07090476
Date Last aer_uraey tested 9-21 -12
Certified Tests Allen Stevens
�/� <<
Cent. Tester Na. BP0009860 Date 1 1 -30 -12
Wtiit�c - Custatner's Copy Yellow -City Copy Pink - Tester's Copy
REDUCED PRESSURE PRINCIPLE ASSE21 -LBLY
PRESSURE VACLTCTM BRFASCFR
Double Check i%alve Assembly
1st Cheri:
Znd Cheri:
Relief Valve
?sir Inlet
Check Valve
Initial Test
DC- Closed
Closed Tight
Opened at
Opened at
nsid
Tight , J.
Leaked
nsid
nsid
�/ 5� � !,
Leaked
°(�
Dtd IIOL Open O
Leaked o
lZepalrS
and
Materials
Used
Test Af3er
DC- Closed
Closed Tight o
Opened at
Opened at
nsid
licpair
Tight o
nsid
nsid
RP sid
The above is certified io be true.
Firm Name Action Fire Pros
Firm Address PO Box 797 Waxahachie
Gauge # 07090476
Date Last aer_uraey tested 9-21 -12
Certified Tests Allen Stevens
�/� <<
Cent. Tester Na. BP0009860 Date 1 1 -30 -12
Wtiit�c - Custatner's Copy Yellow -City Copy Pink - Tester's Copy