2012_0522 (2)CHECK ONE:
IRRIGATION= DOMESTIC___[]_ FIRELINE__�
BACKYLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: L 17 P
PWS I.D. 9
LOCATION OF SERVICE: 106 N. Denton Tap Rd.
The back low prevention assernbly detailed below has been tested and maintained as required by TCEQ
regulations and is certified to be operating within acceptable parameters.
TYPE OF ASSEMBLY
Reduced Pressure Principle Pressure Vacuum Breaker
Double Check Valve H Atmosphere Vacuum Breaker
Manufacturer Hersey
Modcl Number DDC-11
Serial Number 9811387
Size 811
Located At Vault on SE corner
The above is certified to be mm.
Firm Name Action Fire Pros
Firm Address PO Box 797 Waxahachie
Gauge # 07090476
Date last accuracy tested 9 -21 -11
Allen Stevens
Certified Test=
Cat Tester No. BP0009860 Dam 5-22-12
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VACUUM BREAKER
Double Check Valve Assembly
1st Check
2nd Check
Relief Valve
Air Inlet
Check Valve
Initial Test
DC-Closed
Tight to E
RP--LL—.psidf
Leaked
Closed Tight
Leaked
f t-/
Opened at
nsid
Opened at
sid
Did not Open 0
id
Leaked
Repairs
and
Materials
Used
Test After
Repair
.I
DC-Closed
Tight ❑ i
RP sid
Closed Tight C
Opened at
. si
Opened at
sid
The above is certified to be mm.
Firm Name Action Fire Pros
Firm Address PO Box 797 Waxahachie
Gauge # 07090476
Date last accuracy tested 9 -21 -11
Allen Stevens
Certified Test=
Cat Tester No. BP0009860 Dam 5-22-12
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy