2014_0813_RPZ (2) C�IECK ONE:
IRRIGATION DOMESTIC � FIRELINE
BACI�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REppRT
NAME OF PWS: C � T Y �- �o-c�P�L L
PWS I.D. #
LOCATION OF SERVICE: _�7� A.j- n t n� i o� ��P �L�,���� 7 o I 9
The backflow 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
� Reducrd Pressure Principle ❑ Pressure Vacui�Breaker
o Double Chcck Valve o Amaosphere Vacuum Breaker
Manufacturer /�A �' T S Sizc '2�z.
Modei Iv�mmber 9 S 7 Located At _�')t�HA-�v1�f+� /1��
Scriai N�bcr b F - o �y�l
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Double Check v alve Assembly
lst Check 2nd Checi: Relief Valve Air Inlet Checic Va1ve
Ininal Test DC-Closed Closed Ti;ht Opened at Opeaed at osid
Tight Leal:ed ❑ �_psid _osid
RP- �_� psid 4���
Leal:ed ❑ Did not Open o I,eal:ed o
��
and
Materials
Used
Test Af�er DC-Closed Closed Tight � Opeaed at Opmod at �sid
Repair TiQ,ht o �sid osid
RP sid
The above is ceRified to be true.
Firm Name :�- +-� �c-n v C t��c.k�eo� Cea�tifiod Tester C i�r�t s�o f'rte�2. �r��F��
Firm Address I a�i (.r w�.�`� �e #`�Q3 Cat Tester No. ����f 3 3 0� n� - 3-r y
��q,,Lr�oc.�rbfis,7"x 1saD7 � f ���p'���
G�� fi
(�suge # �$o�ps'��3
llate last accuracy tested �l-��- 13
White - Customer's Copy Yellow - City Copy Pink -Tester's Copy