Fire_0605_2014 CHECK ONE:
IRRIGATION DOMESTIC FIRELINE /t g v P4 S S
BACKFLOW PREVENTION ASSEMBLY TEST' AND MAINTENANCE REPORT
NAME OFPWS: �. G''( - /'r- pPr. /t
PWS 1.D. #
LOCATION OF SERVICE: 0-7/ J 3 r[: + ti .lc_ / /_3 .5 c, Lc. /'� S i rc 11v, ./t-
The back flow 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
a Reducxl Pressure Principle a Pressure Vacuum Breaker
A;1 Double Check Valve a Atmosphere Vacuum Breaker
Manufacturer (tic - r - T S Siz_e .3i
Model Number (70 '71 -2 ') Located At l fov L' c h L a Pc She -c ( Iti
Serial Number �a - O 5
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER
Double Check Valve Assembly
1st Check 1 2nd Check Relief Valve Air Inlet Check Valve
Initial Test DC- Closed Closed Tight o Opened at Opened at psid
5/ hr)//4 Tight o Leaked Ja' psid _____psid
r RP psid �'.
Leaked rT2 Did not Open o Leaked a
and R_epairs izr l -1=t" -)
Materials 6'14 coe c N ce e'
Used
Test After DC- Closed Closed Tight Jar Opened at Opened at psid
a ir
Tight, .dP t _ 8 psid psid
fj 3ji-1 RP et- � psid
The above is certified to be true. q t S
Firm Name /_Ic T.c) -'‘ c - C.-- Certified Testa 1---J fP-Se-1 r W e r. v1
Firm Address P e' ,.. 7S 7 Cert. Tester No. p 0,-9 9 7 D Date (../57
tni Co.�QGv, c LL.-. TY `Jj - fbi
Gauge # CJ 30,900 i
Date last accuracy tested
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy
CIIECK ONE:
IRRIGATION DOMESTIC FIRELINE • .. o
BAC1CFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OFPWS: lc7,0pr /!
PWS I.D. 0
LOCATION OF SERVICE: 1 ik- I -s c°1 i L �+ c / l ZcY S No fc, p f • ✓
The backtlow 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
o Reduced Pressure Principle D Pressure Var+.+.m Breaker
1Z p` IJA Atmosphere Vacuum Breaker
Manufacturer W c - s - r S Size
Model Number 7 5 Located At /c ! - r.4 i4?�r
Serial Number A) 1 3
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER
Double Check Valve Assembly
1st Check 1 2nd Check Relief Valve Air Inlet Check Valve
Initial Test DC- Closed Closed Tight o Opened at Opened at psid
5 no/ t7/ Ti at o Leaked .07 psid _psid
1 c . L RP- 3.G usid
Leaked 127 Did not Open t7 Leaked C7
and
Materials pPc Cam. a C /cc a. Gh, 1 .e-
�cckl =�cc/
Materials Caecd
Used
Test After DC- Closed Closed Tight /29 Opened at Opened at _psid
Repair Tight _-3 -z� � c _psid nsid
RP psid
The above is certified to be true. y r fj
Firm NameAL G' n Certified Tester N I.Jc -* »z W c..
Firm Address ` V:;Q - :c 7 c 7 - 7 Celt Testa 6U 6 No. (900 91 � 5 Date � /4
vic )rcv.c ch� T� 7� / b5
Gauge # 03c 6 oa i `�l
Date Last accuracy tested
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy