2014_0703 (4) CHECK ONE:
IRRIGATION X DOMESTIC FIRELINE
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: e-,"7 G' F e- p f /! ( 9 ) -
PWS I.D. # QQ�� 1+
LOCATION OF SERVICE: BO/ 1111 IoYI ��1
The backilow 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 O Pressure Vacuum Breaker
4d Double Check Valve o Atmosphere Vacuum Breal,-er
Manufacturer 4(4 • 7. Size
Modell umber / 0(3 -7Al / Located At v�/1�t��181'_S' L�B��g.r t�� �
"%
Serial Number 96
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BRF'AICER
Double Check Valve Assembly
1st Check tad Check Relief Valve Air Inlet Check Valve
Initial Test DC- Closed 2-0 Closed Tight RC - Opened at Opened at nand
Tight ..lsk Leaked Z_y o nsid _Hard
RP- p aid
Leaked a Did not Open o F i� o
Repairs
and
MateriaLs
used
Test After DC- Closed Closed Tight o Opened at Opened at --p sid
Repair Tight 0 nsid psid
RP • sid
The above is c to be true. J
Firm Name Atli li r) vi r re Pete i Certified Tester ts� ce":,-1 S Tb d
Firm Address /3!`< 717 Cert. Tester No. ,�fbC f�1`�sa I Date I /'�f1
L(JaVataChte' Tx 951
Gauge # ii00 7.
Date last accuracy tested , ? / 5 / 6
White — Customer's Copy Yellow — City Copy Pink — Tester's Copy