2012_0724 (4)94plZm
IRRIGATION' Y, p DOMESTIC-- FIRELINE
NA. ME OF PWS: L j7 e)
PWS I.D. 4 2,4 ci 6 yk C,
LOCATION OF SERVICE:, 58 5 P-o,,c, Ltj 4-2oo
r
The backllww prevention assembly detailed below has been tcsted and maintained as required by TCEQ
re,oulations and is certified to be operating within acceptable parameters.
TYPE' OF ASSENMLY
o Reduced Pressure Principle C. Pressure Vacuum Breaker
Double Check Valve c Atmosphere Vacuum Breaker
Manufacturer &4- L 's Size ez it
Model Number 00:z tj I Located At 1%'Llf-h jau-
Serial Number 1,9)q FS
REDUCED PRESSURE PRINC1PLE.-AsSSEINIBLY PRESSURE VACUUM BREAKER
Double Check Valve Assembly
1st Check 2nd Check- Relief Valve Air Inlet Check Valve
Initial Test DC-Closed ? Closed Tight K Opened at Opened at osid
Tight Leaked sid --psid
RP------.psid
Leaked ❑
Did not Open ❑ Leaked ❑
Repairs
and
Materials
Used
Test After DC-Closed Closed Tight C Opened at Opened at psid
Repair Tight CI psid osid
RP--_---psid
The above is certified to be true.
Firm Name Jdiuka Lz-c- P40S Certified Tester IL-nrJ
Firm Address A Lb-g- 7r, —7 Cezt Tester No. (JQQ ' Dam 2—
Gauge 4
Date last. accuracy tested
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy