2014_0701 CIIECK ONE.
IRRIGATION � DOMESTIC FI SEL
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF CORRELL
PWS I.D. # r , /
LOCATION OF SERVICE: Pig ig /� �j„
The bacldiow prevention assembly detailed below has been tested and rr+airrrairred as required by TNRCC
regulations and is certified to be operating within acceptable parameters.
TYPE OF ASSEMBLY
C Reduced Pressure Principle 0 Pressure Vac-utnn Breaker
[]/ Double Check Valve D Atmosphere Vacuum Breaker
ti
Manufacturer /'L li., Size
Model Number Located At f
Serial Nummber /� G / 9
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI ER
Double Cheek Valve Assembly
1st Check tad Check Relief Valve Air Inlet Cheek Valve
Initial Test DC- Closed Closed Tighe 7 0—Opened at Opened at paid
Tight Leaked o paid _psid
RP- . S psid
4 , s jam Leaked t7 Did not Open o Leaked o
Repairs
and
Materials
Used
Test Attar DC- Closed Closed Tight o Opened at Opened at osid
Repair Tight [7 psid nsid
RP psid
The above is certified to be true.
Firm Name l / s „: Lei, . K , Certified Tester r i d / /-7
Firm Address ��' —1i. i7 _ Cent Tester No. cr 7 Date ?- /7
Gauge #
Date last accuracy tested �-
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy