2013_1105 (2)CIIECK ONE,.
IRRIGATION
DO&IESTIC
I'IRELIN E
BAC 'LOW P EVE (1ON ASSZ,),I3LY TEST IN—D INLUNTI NANCE REPDRT
NAME, OF PWS: --
PWS I.D. # l
LOCATION OF SERVICE: t 1. o _ c4e I LJ
The backfiow 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 ❑ Pressure Vacuum Breaker
VDouble Check Valve ❑ Atmosphere Vacuum Breaker
Manufacturer Wc4-1 S Size
Model Number ` JLl b T>A Located At i4 6•JLe- � #°
Serial Number 11600ira7
The above is certified to be true.
Firm Name D55 T�•re !�2La---e
Firm Address 122:L S M ", i t er- R x
be, tic,5 —73;)-3`d
Gauge # 6,13 j�` _�
Date last accuracy tested �-- ),a- V3
Certified Tester ,, I, -
Cent. Tester No. l 0- 1 c Date
REDUCED PRESSURE PRINCIPLE ASSEIN BLY
PRESSURE VACUUM BREAKER
Double Check Valve Assembly
1st Check
tad Check
Relief Valve
Air Inlet
Check Valve
Initial Test
DC- Closed
Closed Tight
Opened at
Opened at
osid
Tight
RP -1, `7 Ds id
Leaked ❑
Leaked a
—psid
osid
Did not Open ❑
Leaked ❑
i
Repairs
and
Materials
Used
Test After
DC- Closed
Closed Tight o
Opened at
Opened at
osid
Repair
Tight ❑
osid
osid
RP sid
The above is certified to be true.
Firm Name D55 T�•re !�2La---e
Firm Address 122:L S M ", i t er- R x
be, tic,5 —73;)-3`d
Gauge # 6,13 j�` _�
Date last accuracy tested �-- ),a- V3
Certified Tester ,, I, -
Cent. Tester No. l 0- 1 c Date