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2013_0514_RPZCHECK ONE: IRRIGATION DOMESTIC ✓ FIRELINE BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS PWS I.D. # C-;4y o P Co.1 11 LOCATION OF SERVICE: 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 ❑ Pressure Vacuum Breaker ❑ Double Check Valve ❑ Atmosphere Vacuum Breaker Manufacturer Size Model Number ©gn�I -3 Located At Serial Number 31,0 0(y 3 F a /4! '54OGk-- Poo,! The above is certified to be true. Firm Name ,aST- _ Certified Tester 1�( Firm Address �s`f a+�'4 a1 at Tester No. A00 —VM ""SDate5 Gauge # V& oi/ %3ry Date last accuracy tested 7-/&-/2- 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 Closed Tight Opened at Opened at osid Tight Leaked ❑ .�`% �psid osid RP- 94 sid TQ-C-6 Leafed ❑ Did not Open ❑ Leaked ❑ Repairs and Materials Used Test ABer DC- Closed Closed Tight ❑ Opened at Opened at flsid Repair Tight ❑ osid osid RP sid The above is certified to be true. Firm Name ,aST- _ Certified Tester 1�( Firm Address �s`f a+�'4 a1 at Tester No. A00 —VM ""SDate5 Gauge # V& oi/ %3ry Date last accuracy tested 7-/&-/2- White - Customer's Copy Yellow - City Copy Pink - Tester's Copy