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2012_0828 (6)CIIECK ONE. IRRIGATION DOMESTIC FIRELINE C/ BACKFI.OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT M�i7�u��Za1�� :`L►9 CITY OF �'OPPELL PWS I_D. # LOCATION OF SERVICE: ���� -� �p =l"�- � ��-S � ��' -�� � "� �� The bacl�low prevention assembly detailed below has been tested and maintained as requu�ed by TNRCC regulations and is certified to be operating within acceptable parameters_ TYPE OF ASSEMBLY C Reduced Pressure Principle C Pressure Vac-tn+*n Breaker �_ Double Check Valve o Atmosphere Vacuum Breaker Manufacturer % -ems Sizc �.ri Model Number ��'�' Located At �� 5 t C�sZ -- w"�^�� serval Number � ��3 1 � The above is certified to be true_ Fitm Natae A � ��w.,.- �i ><-t p� � Certified Tester iS f-•-� ri e_ �� �'L ✓ Firm Address ��' �D y � 7 7 Gl�� -� Cert. TestQ No_ � Po �_� � i.S �J Date � Z 8� / 2_ Gauge # 0 7" 9 ©V X � Date last accuracy tested - 3!- 1 �— White - Customer's Copy Yellow -City Copy Pink - Tester's Copy REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BRF'AT�R Double Check Valve Assembly 1st Check � � � 2nd Check '' , [,! Relief Valve Air Inlet Check Valve Initial Test DC- Closed Closed Tight � Opened at Opined at nsid Titdzi Leaked t7 vsid nsid RP- vsid ��� p Did not Opm o Leaked � �P�� and Mata-ials Used Test Ai?er Repair DC- Closed Tight o Closed Tight a Opined at vsid Opened at nsid nsid RP sid The above is certified to be true_ Fitm Natae A � ��w.,.- �i ><-t p� � Certified Tester iS f-•-� ri e_ �� �'L ✓ Firm Address ��' �D y � 7 7 Gl�� -� Cert. TestQ No_ � Po �_� � i.S �J Date � Z 8� / 2_ Gauge # 0 7" 9 ©V X � Date last accuracy tested - 3!- 1 �— White - Customer's Copy Yellow -City Copy Pink - Tester's Copy