2013_1105CIIECIK 014Ea
IRRIGATION
DOMES=
I'IFiE LPLIE
BAC CW PREYE11 TIDN ASSL;°,IBLY 'IBS T,k Yl. NTEINAINCE RZI RORT
NAME OF PWS: Cf�+t C5 I
PWS I.D. 4 NIA
LOCATION OF SERVICE: L L
The backflow prevention assembly 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 1) Pressure Vacuum Breaker
Double Check Valve ❑ Atmosphere Vacuum Breaker
Manufacturer (k)c4l --1_s Size 12
Model Number 00-7801 Located At _ '- ei:h -,3, C6- iA
Serial Number 0—M&
The above is certified to be true.
Firm Name h6S
Firm Address 1 G' S ;11 Rd 0-f.�1�
Gauge # 0,513d i1
Date last accuracy tested
Certified Tester
Cent. Tester No. ,191,2/ 35k q Date 'LL/3
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VACUUM BAR
Double Check Valve Assembly
1st Check
2nd Check
Relief Valve
Air Inlet
Check Valve
Initial Test
DC- Closed
Closed Tight dK
Opened at
Opened at
osid
pri
Tight
RP- 1, sid
Leaked ❑
Leaked ❑
P'
_psid
osid
Did not Open ❑
Leaked ❑
Repairs
and
Materials
Used
Test After
DC- Closed
Closed Tight ❑
Opened at
Opened at
®� sid
Repair
Tight ❑
psid
osid
RP sid
The above is certified to be true.
Firm Name h6S
Firm Address 1 G' S ;11 Rd 0-f.�1�
Gauge # 0,513d i1
Date last accuracy tested
Certified Tester
Cent. Tester No. ,191,2/ 35k q Date 'LL/3