2014_0424CHECK ONIs
IRRIGATION
DOMESTIC
FIRELINE � � y �a f f
BAC�ZOW PREVENTION ASSIIVIBLY TEST AND CE REPORT
PWS LD_ #
LOCATION OF SERVICE: '� r � ..� + !"C � .n c_ (_� r
The backflow prevention assembly detailed below has been tested and maintained as required by TCEQ
regulations and is certified to he operating within acceptable parameters.
TYPE OF ASSEMBLY
D Reduced Pressum Principle D Pressias vacuum Breaks
Double Chock Valve � Atmosphere V Y acuimm Breaker
MaIIl.ifaCLi>fCr `A Y T S Size / /"�
Model l�+umba CaL�`7 t�'1 � Located At � G:_+t T � .n �i o�.
Serial I�iizmber 30y'c�b Jac � 5 � � �
"� Ids/ /(�/
The above is certified to be true. y + S
Fir�N `•• �v� Certified Tester GJc.I n z lil � v► v� �
Firm toss Q{1 .�x 7cs l t�.�„c. 7Y Celt Testa No. /'_t('Yi S� /.;r s Date c /��7H�C z/
? 5l (nom
Gauge # [,y 3L1c J � J
Date last accuracy tested ��J'�
f�)
White - Customer`s Copy Yellow -City Copy Pink - Tester's Copy
REDUCED PRESSURE PRINCIPLE ASSENLBLY PRESSURE VACUiJM B R_F'si[t 2 R
Double Cheek Valve Assembly
-�r �•
Ist cb eelc
2nd Checl:
Relief Valve Air Inlet
Cheek Valve
Initial Test
DC- Closed
Closed Tight [7
Opened at Opened at
Tight O
Loaled O
n sid n sid
RP -pstd
r -�t� �
Did not Open o
r �iKt a
��
and
� � �Cv�
c 3/� J /��
r �v � z aJi� cam"+' c C
h �
Materials
used
Test ARer
DC- Closed
Closed Tigbt t�
Opened at Opened at
psid
Report
R �� _ _ � Q�
�_ �
n sid n sid
"� Ids/ /(�/
The above is certified to be true. y + S
Fir�N `•• �v� Certified Tester GJc.I n z lil � v► v� �
Firm toss Q{1 .�x 7cs l t�.�„c. 7Y Celt Testa No. /'_t('Yi S� /.;r s Date c /��7H�C z/
? 5l (nom
Gauge # [,y 3L1c J � J
Date last accuracy tested ��J'�
f�)
White - Customer`s Copy Yellow -City Copy Pink - Tester's Copy