2014-1210 C�IBCK ONE:
IRRIGATION DOMESTIC FIRELINE
BACI�'i.OW PREVENTION ASSEIV�LY T'ES?AND MAII�1T'ENANCE REPORT'
NAME OF PWS: �� D ` � � �CQ S. � E.I I �����T�
�ws�D.# � s ° � 9
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LOCATTON OF SERVICE:�� • ��� � NU : � . < k��I C�.
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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 ASSE1v�LY
o Rcduad Pr�ss�ae Priaciple ❑ Pressiae Vacut�Breaker
t�� Doubk Check Valve ❑ Amiosp Vacu�Brealoer
�� ���
M��� \��� s�
Model N�ber ��� ���L� Locaud At ��Cr.`�.,Y
Serial Ni�ber ���`��
REDUCED PRESSURE PRINC'IPLE ASSEMBLY PRESSURE VACUITM BREAI�R
Double Check Yalve Assembly .
lst Check 2 d Check 'ef Vah►e !,ir Inlet Check Vah►e
Ininal Test DC-Closed Closeii Tight Opeaed at Opeaed at �nsid
a(�� Ti�t� ,�, � � o _�Dsid _�sid
RP-_,psid i
Leai;ed o Did not Opm o L,esked ❑
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aad
Materials
Used
Test ARa DC-Closed Closod Tight o Opmed at ppeaed at _,psid
Repair Tight ❑ ,__�sid _�sid
RP id
The above is cxnified to be true.
Wri�ht Becidlow 8 PLBG
Firm Na�e Catified Tester �o�n e y �i�G�' �-�,'�
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Firm Address �'TX 7b150 Cest Testa No. � S�Date�_� � �l.S
Ga�e � / 3 $ Z 3 �r� �1��5 "r'k - �i g E ,
llate last accuracy tested �����l'� ^
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy