2013_1105 (3)CIIE'CK ONE-.
IRRIGATION D,0M STIC FIRELIPIE_Z
BACXFLO W FREVEN 'I ON ASSL.N,13LY TEST AND NLUNTEYANCE RET'''ORT
NAME OF PWS: -
PWS I.D. # A
LOCATION OF SERVICE: 10'-1 he-4-h r=( LA
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
0 Reduced Pressure Principle 0 Pressure Vacuum Breaker
❑ Double Check Valve ❑ Atmosphere Vacu= Breaker
Manufacturer U)rx�- S Size R I
Model Number -7 2 4' Located At V -0 W 14 A/ I r7 '
Serial Number
The above is certified to be true.
Firm Name NSS r, re. C2 w^_ �-� Wc- Certified Testes _ i Firm Address I c2a.C5 L', 11a, ILA �1Q-2- Cert. Testa No. f9 `° tl� Date i� �--13
1x1kfc,5 75 38
Gauge # ®313 j&r
Bate last accuracy rested - J?j
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
Closed Tight
Opened at
Opened at
osid
P. •
Tight
RP- a c- .psid
Leaked ❑
Leaked ❑
psid
osid
Did not Open ❑
Leaked ❑
Repairs
and
Materials
Used
Test After
DC- Closed
Closed Tight o
Opened at
Opened at
osid
Repair
Tight ❑
psid
osid
RP sid
The above is certified to be true.
Firm Name NSS r, re. C2 w^_ �-� Wc- Certified Testes _ i Firm Address I c2a.C5 L', 11a, ILA �1Q-2- Cert. Testa No. f9 `° tl� Date i� �--13
1x1kfc,5 75 38
Gauge # ®313 j&r
Bate last accuracy rested - J?j