2014_0709 (2) CIIECK ONE.
IRRIGATION DOMESTIC FIRELINE
BACICFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF CORRELL,
PWS I.D. t>s � A �� ppel 1
LOCATION OF SERVICE: 1 i vet �Oak's" 17Sck/I4 Zia I q 54440 / /v' eCN�O'�/ CA ye
The backdlow prevention assembly detailed below has been / tested and mairnrained as required by TNRCC
reaulations and is certified to be operating within acceptable parameters.
TYPE OF ASSEMBLY
C/ Reduced Pressure Principle C Pressure Vacuum Breaker
Double Check Valve Atmosphere Vacuum Breaker
1r
Manufacturer 1/1/A r i S //�� / ' / Size
Model Plumber r 7 ! DC. D./n 7 6 V Located At Vti/it SAV OT
Serial Number N' /-7/a
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAF:ER
Double Check Valve Assembly
1st Check 1 2nd Check / Relief Valve Air Inlet Check Valve _
Initial Test DC- Closed / Closed Tight Od Opened at Opened at osid
Tight
_Ls_k _L-_k df Leaked 0 psid osid
Y�S RP- osid
Leaked o — Did not Open O Leaked
Repairs
and
Materials
Used
Test After DC- Closed Closed Tight o Opened at Opened at osid
Repair Tight 0 osid osid
RP • sid
The above is certified to be true.
Firm Name To I ere Certified ester P(\ C \ 't \G. - ' V \ C 1 C ) F l
Firm Address C —r r Z )4 J1aS', �f Cert. Tester No.�\0 C ' IU 9 I _ f Date - 774///-7
Gauge #
Date last accuracy tested `e /
White - Customer's Copy Yellow - City Copy Pink - Testers Copy