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2013_0708 (5)
CHECK ONE: IRRIGATION X DOMESTIC FIRELINE BACEFLOW PREVENTION ASSEMBLY TEST AND MALVr E:NANCE REPORT NAME OF PWS: L 17 \1 e i t''�' - L PWS I.D. 9 YA t LOCATION OF SERVICE: u—i � -1'J -4 )o The backilow prevention assembly detailed bolo x 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 Vaccnaa Breaker Double Check Valve ❑ Atmosphere Vacuum Breaker Manufacturer (1�Q� Size Mode: Number ©O Z k Yl Serial Number 43 y8& 2" The above is certified to be true. Firm Name kiJ L' r1 r i f s Firm Address PC) &C -147 Gauge # OG, 1 1 5 Date last accuracy tested 5 j2_ Certified Tester �Ualil 4L)L- b rJ Cat. Testa No.lt Date ,,( 5 White - Customer's Copy Yellow -- City Copy Pink - Tester's Copy REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER Double Check Valve Assembly Ist Check- 2nd Check Relief Valve Air Inlet Check Valve Initial Test DC- Closed 2 2- Tight vY RP —_psid Closed Tight )if Leafed 2.0 ❑ Opened at psid Opened at nSid nsid Leaded ❑ Did not Open ❑ Lcakei ❑ Repairs ,and I Materials '' Used Test After Repair DC- Closed Tight ❑ Closed Tight ❑ Opened at nsid Opened at Sid nsid RP sid The above is certified to be true. Firm Name kiJ L' r1 r i f s Firm Address PC) &C -147 Gauge # OG, 1 1 5 Date last accuracy tested 5 j2_ Certified Tester �Ualil 4L)L- b rJ Cat. Testa No.lt Date ,,( 5 White - Customer's Copy Yellow -- City Copy Pink - Tester's Copy