2014_0708 CHECK ONE_
IRRIGATION DOMESTIC ✓ FIRELINE
BACKFLOW PREVENTION AS? LY TEST / AND MAINTENANCE REPORT
NAME OF PWS: Coppe if / 7 f y n Se. A /
PWS I.D. #
LOCATION OF SERVICE: / � • ► UYhW62/
The bacldlow prevention assembly detailed below has been tested and maintained as required by TNRCC
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 l ! ei 5 Size 2 /Z
Model Number 3 1 S Located At GJ / � / /yi
eZZ
Ser ial Ntmmber / _ / 9
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREA/CER
Double Check Valve Assembly
1st Check 2nd Check Relief Valve Air Inlet Cheek Valve
Initial Test DC- Closed Closed Tight ❑ Opened at Opened at _psid
Tight 0 Leaked ❑ 2. 2 psid _psid
p C(4 RP- C o" 7 psid
Leaked o Did not Open ❑ Leaked ❑
Repairs
and
Materials
Used
Test After DC- Closed Closed Tight O Opened at Opened at _psid
Repair Tight ❑ _psid _psid
RP psid
The above is certified to be true. Q I
Firm Name l .� pr.e 1 I rr 5 � Certified Tester pp p ) a e.); d l -�t't 1
Firm Address 13 w 3 17Ti 1 � ✓. iX
Cert. Tester No. OC]n62/ 2jDate ,1 ///4
Gauge # ZS 'R O Cr)
Date last accuracy tested 4/S / / 3
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy
CHECK ONE:
IRRIGATION DOMESTIC / PIRELINE
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
N NAME OF PWS: C n p pel I i� h � C , , I 1'`!7,A"")
PWS I.D. # RR tt
LOCATION OF SERVICE: I OS� YTli�i
The baeldlow prevention assembly detailed below has been tested and maintained as required by TNRCC
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 (A -lG`fl� S Size -3/4 l
Model Number 9 O 9 // (X �l ``f Located At 6-3
//
Serial Number u4 Z f !v O to
- - -
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREA.IC R
Double Cheek Valve Assembly
1st Check 2nd Check Relief Valve Air Inlet Check Valve
Initial Test DC- Closed Closed Tight ❑ Opened at Opened at vsid
Tight ax Leaked ❑ 2 �/ paid vsid
p ` RP- �o. vsid
Q� J Leaked ❑ Did not Open ❑ Leaked ❑
Reps
and
Materials
Used
Test After DC- Closed Closed Tight 0 Opened at Opened at vsid
Repair Tight o vsid vsid
RP psid
The above is certified to be true. (� 1
Firm Name e l p � 1 \ ' �� Certified Tester IMO-V of 1 _!'Y- 1 '
Firm Address 1� 03 f CA Y9 er"" ✓ Cert. Testa No. B2ooak7 Date - 71F3 f / `y
Gau #
Date last accuracy tested C A l � I t 3
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy
e ?A^Ci'G','S`iP'4aN• 'w ..,. 9 "'Y•Y ra Mt`r my .. .. ..
CHECK ONE:
IRRIGATION DOMESTIC �� PIRELINE
BACK:FI.OW PREVENTION ATE19LY TEST AND MAINTENANCE REPORT
NAME OF PWS: Ce,p r-el i 11 C -.[-‘o� i
PWS I.D. # \ 1
LOCATION OF SERVICE: I ( J-� • Pelr 1 ∎13 =
The bacltilow prevention assembly detailed below has been tested and tr.ainrairZed as required by TNRCC
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 ( .,0a-TL-k`s Size ti `
Model Numb Q IV1 - 3 Located At W es-A " al e-z 'Z
Serial Number Z S '-1 -1 1 p
-
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BRE. ICER
Double Cheek Valve Assembly
1st Check 2nd Check Relief Valve Air Inlet Check Valve
Initial Test DC- Closed Closed Tight cfc Opened at Opened at psid
Tight, ` C' Leaked ❑ �{ psid � sid
VaI,S RP - , psid
Leaked ❑ Did not Open ❑ Leaked ❑
Repairs
and
Materials _
Used
Test After DC- Closed Closed Tight ❑ Opened at Opened at psid
Repair Tight ❑ psid psid
RP psid
The above is certified to be true.
t / {�,, ° /
Firm Name C-' P PQ 41 � S � Certified Testes Da U I a X 115 I.
`- , r
T
Firm Address l'--- 03 °-1--
3 ( � "` C-c ` Y �' � �, �
'r Cert. Tester No. - � -Date ' 1 e ji
Gau # - 2--8 0.0,0
_ ,.. =Date last accuracy tested g/ / 13
White - Customer's Copy Yellow - City Copy Pinlc - Tester's Copy
9
CIIECK ONE:
IRRIGATION DOMESTIC r/ FIRELINE
BACICFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: C FA P lx\ �-1 �� n ,
PWS I.D. #
LOCATION OF SERVICE y \ U �y
S PQ WOC -- (
The bacidlow prevention assembly detailed below has been tested and Jrnwirnrairted as required by TNRCC
regulations and is certified to be operating within acceptable parameters.
TYPE OF ASSEMBLY
�C Reduced Pressure Principle ❑ Pressure Vacuum Breaker
❑ Double Check Valve ❑ Atmosphere Vacuum Breaker
Manufacturer _ UJC2 *� Size 3/4 r
Model Number 9 0 � 9 Located At E-G S� ine ZZ
Serial Number S r 9 "[ S Z
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BRE-aICER
Double Check Valve Assembly
1st Check tad Cheek Relief Valve Air Inlet Cheek Valve
Initial Test DC- Closed Closed Tight ❑ Opened at Opened at psid
Tight Ir Leaked ❑ 3. 7 psid psid
Vag' RP- 7 2-psid
Leaked ❑ Did not Open ❑ Leaked ❑
Reps
and
Materials
Used
Test After DC- Closed Closed Tight ❑ Opened at Opened at nsid
Repair Tight ❑ nsid psid
RP psid
The above is certified to be true.
Firm Natne C-ArDeP C I I � S L) Certified Tester
Firm Address ` ( ✓ art_ Testa No. l l p l er/ i r2 Date - 1 9) (/ 4 4
Gauge # z j00 Q
Date last accuracy tested 9 j //3
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy