2012_0312 (5)cllECU �oNE=
IRRIGATION DO1L!IESTIC
FIR�:LINE
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: L. r ? �� ,�"y�T
rsl
PWS LD- #
LOCATION OF SERVICE: ��G A � l L �.✓� ��
The bz�ckilc >w prcve,ntion assenZbly detailed below has been tested and maintained as required by TCFQ
re��ulations and is certified to be operating within acceptable parameters.
TYPE OF ASSEMBLY
o„ Ruiuc�i Pressure Principle Q Pressure Vactnna Breaker
`,�t`f�/ D'ou'ble Check Valvo o Atmosphere Vacuum Breaker
Manufacturer WcaTT rj Size 3���
Model Number d0% ►^'► t Located At � -� ✓C u [ T-
Serial Nimmber 3 0 8a
White - Customer's Copy Yellow -City Copy Pink - Tester's Copy
REDUCED PRESSURE PRINC�LE ASSEMBLY
PRESSURE VACLT'IJM BRF'air�'R
Double Check Valve Assembly
1st Chec3: 2nd Check ReiieF Valve
Air Inlet Chec3c Valve
Initial Test
DC- Closed Closed Tight � Opened at
Opened at nsid
Tighe 1 • (� � Leaked 1. 4j/` o nsid
nsid
RP -__ ostd
��`� C
Did not Opea n r r >>=� p
�P airs
and
Materials
Used
Test ARer
DC- Closed Closed Tight a Opeacd at
Opened at nsid
RcP�
Tight Q asid
nsid
RP sid
The above is certified to be true. Y� `l
Firm Name �
�• �¢ Cutifiod T //l_
_a�-
Firm Address
(G�T• /y�•J
i U i� o )O 7 % 7 Cert. Tessa No. t'ooG '/� � Date 3 /�a /� �
_Q
O�Jo � l�1 G G N �c
gauge # _3�y4�f�
llate Iasi accuracy tested j �//
White - Customer's Copy Yellow -City Copy Pink - Tester's Copy