Riverchase (6.4)-CS 980908 P.O. Box 734
Coppell, Texas 75019
(972) 621-0126
FAX (972) 929-1929
To:
WE ARE SENDING YOU [] Attached .--] Under separate covervia the following items:
[] Shop Drawings ~ Pdnts [] Plans ~ Samples ~. Specifications
[] Copy of Letter _~ Change Order [] ~
COPIES DATE NO. ~._..~(~ DESCRIPTION
THESE ARE TRANSMITTED as checked below:
r Approval
r Your Use
[--I As Requested
u~ For Review and Comment
= I FOR BIDS DUE
[] Approved as Submitted ~' Resubmit Copies for Approval
[] Approved as Noted [] Submit __ Copies for Distribution
[] Returned for Corrections [] Return Corrected Prints
19__
REMARKS
[] PRINTS RETURNED AFTER LOAN TO US
COPY TO _~J'~(::~
SIGNED:
If endosures am not as noted, Idndly notifY us at once.
~tlECK ONE: ~,~
IRRIGATION
DOMESTIC FIRBLH~IE
BACKFLOW pI~VENTION ASS~LY TEST _AND. MAiN"i'F, NAN~CE REPORT
PWS LD. ~
750 5.
The bac, k~ow prevention assembly detailed below has be~m tested and mammi.ned as r~ by. TNRCC
r%m.ti, aziom and is c~"fified to be op~"af.~g within acceptable parameters.
Manu.facrurer
Mock:l Number
Serial Number
.~::duc,.ed Pressu~ Principle
uble Ch~ck Valve
O07m/
TYPE OF ASSEMBLY
~ Pr~m Vacuum Brealm'
m Atmosph~'~ Vacuum Br~k~r
Siz~ / l/
BEDUCED PRESSURE PRINCIPLE ASSEi~BLY PRESSURE VACUUM BREAKER
Double Check Valve Assembly
,] 2nd Check l~ih.f Valve Air Inlet Check Vnlve
Ist
Check
initial Test DC-Closed osed Tight ~ /
L~. Opeaed at Opeaed at psid
Ti~kt . ci~ ~d ~ , psid psid
R~- /. ~psid
Le~_k_~l ~ Did not Ope~ I2 L~aked z
and
Matmals
Used
Test AR~ DC-Closed Closed Tight ~I Opened at Opened at ~sid
R~air Tight KI psid psid
RP psid ..................................
The above is certified to be true.
Cert. Testn' No. Y
Gauge # a~-Z//y~/
Date !_~-~t accuracy tested
White - Customer~ Copy Yellow - City Copy Pink - Tezter~ Copy
CtlECK ONE:
IRRIGATION
DOMF_~TIC / FIRELINE
BACKFLOW PREVENTION ASS~LY ~ AND MAIN'r~NANCE REPORT
Fo; do
PWS I.D. #
LOCATION OF SERVICE:
The backflow prevention assembly detail~ bdow has be~n test~i and maintaimd as ~ by. TNI~.CC
mgulatiom md is c.~d to b~ operating within acc~table paramours.
Manufactm'~r
Mod~l Numbs'
Serial Number
~ Double Ch~:k Valvc
O0 7/~ /
TYPE OF ASSEMBLY
n Pr~s~ Vacuum Br~l~
Atmosplzr~ Vacuum Brcalo:r
s~
~,~^, /~re^ t ~I~ ~,'~,'~.
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER
Double Check Valve Assembly
1st _f~eck [ 2nd Check Re. lief V~lve Air Inlet Ch~k Valve
T.itid Test DC-Clos~ /61'osed Ti~t ~acned at Opened at psid
Ti!~ 0~': Le.ak~ Cl osid psid
P~- ],~ .sid
L~k~ a Did not Open CD L~akcd ~
Materials
Used ....
Test After DC-Closed Closed Tight o Opted at Opened a~ psid
Repair Tight o psid psid
R2 p-~id -
above is certified to ~ true.
C~t. T~-~r No.~.S'?/?g,.2?O Date
Date last accuracy tested
White - Customer~ Copy Yellow - City Copy Pink - Tester~ Copy