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2015_0720 CfIECi( (1NE: 1HRIGATIC�N 1]Oh7ESTIC FIRELINE � BACKFLOW PREVE:VTION ASSEMBLY TEST AND MAINTENANCE REPORT NAT�IE OF P�VS: ���� 'l C'� (� L_�(�� •.�/ PWS ?.D. � LC?CATION OF SERVICE: �I '�V'V�M[�r1� �Tl��c hackfl����� pr���ention assembi�� detailed h�1�7��� has heen t��.rci ,�nd m3iutained a's required h�� I'C't;Q rc�rul�i�it,ns and i� ccrtiticd tc� he oE�e.r�tin�����ithin �icce�tablc p�n�ai��eters. TYPE OF ASSEIv�LY � Re�uccd Pressure Princioic � Pressure Vacu�mm Brcaktz �' Double Chxk Valvc � Atmosphere Vacuum Breal:� g,, Manufacturc: �-�S Sizc Modei'vumber ��� Locaud At �oc,�`��tkLFS'� �'c�r�r I vi UQu �'�" Se:ial Nu�nba �On 2�e REDUCED PRESSURE PRINCTPLE :�SSE:I�LY I PRESSU'RE VACUIP:�i BREr1KER Double Check v alve�►ssembly , I� ist C3ecl: 2ad Checl: Relief Valve :�ir Ialet Check Va1ve Ininal Tat DGC:osed .�j. a Closed Ti�ht � Opened at Ovcaai at nsid � Ti�i � Lcal:cd 3.� ❑ �sid �sid RP-�psid Leai;ed C Did not Opea � Leal:ed � �P� � �a uau�� li sed Test P.fter DGClosed Closcd Tight ❑ Opcncd at Opcncd at �sid R.,-pair Tight ❑ nsid osid R.P sid The above is catified to be tnu. Firm Name �f ��� �Vr� 1 ICLJ1 CG1u11G�TC$�Cr Ul � �L1��1� Firm Address��OX /`I 7 Cert. T�ta No. ���I�'��Dsu ? 20 ��j (�l kLi�CfC dl LQ �,�C (�auge # ����75 llate last accuracy tested White - Customer's Copy Yellow - City Copy Pink-Tester's Copy c�i�c� ux�,: iRRIGA`I'I.ON DODiESTIC FIRis'LINE � BACI�'LOVF'PREVE'VTI�N ASSEIVI�LY TEST AND MAINT'ENANCE REPURT NAME QF PWS: � � �`l C' h� j�--�_�p r��� PV4'S I.D. � LOCATION OF SERVICE: �� �YV11�1[�►�� �I�l�e h.ickflu��� }�t������tic�n assei��bi�� detailcci belu��' has been t��i;:d ar�c1 iT�aintained as reyuired h�-"I�CLQ rctirulutiiai�s and i. rcrtitied to h� ��er�jtin�a ��ithin acr��t,�blc parameters. TYPE OF ASSE:��BLY ❑ Rcduccd Pressurc Princi�lc � Pressurc Vacu�Brcakes ��" Double Cheek Valve c Atmosphere Vacuum Brealce: Manufac:urc: �Q��S S izc 3�y" Model'vtmmber , C���]MI LocatcdAt �Sn���i1�4S� �'dYy�e� j� l/Qcc ��- Se:ial'.vumber `��D Co 7 � REDL'CED PRESSUR.E PAINCIPLE :�SSE:�LBLY I PRESSURE V�CUIJM BR��R � Double Chetk�alve Assembly � � lst C3ec1: :,nd Checl: Relief Valve Air Inlet C6eck Valv� ! Iniaal 7cst DGCiosed �Pj Closed Tioht � Opened at Ozsened at asid � Ti�it .� Lea}:e� �� ❑ osid osid � R,�-_psid r Lcai;ed c Dtd not Opm L.ral:ed � �� �and Matrrials liscd Test After DGClosed Closed Tight O Opcncd at Opcaed at Qsid Repair Tight C nsid osid R.P sid Thc above is catified to be true. Firm Name �Tl�� 1 1�r� �_� CQ�fiCd TCStQ ��Q N1 �r�� Firm Addrass�"/,C�k /`l� Cat Testa No. �����>)Date � 2-0 �5 �(„4�cc kr.c l�G c ll t,Q I k� t�auge # �p��(�7'7j� llate last accuracy tested White - Customer's Copy Yellow - City C�y Pink-Tester's Copy CHEC#� �Ni;: IHKIGA'I'ION ! ll0l�'IESTIC X FIHI'sLINE BAC.'I�LOW PREVE:V'I'ION ASSEMBLY TEST AND MAWI'ENANCE REPORT N�MEOFPWS: �, i�/ �' r L�c-(=���.« PWS i.D. # LOCATION OF SERVICE: ��, '�Yl/�M[�►r►�'� Thc L�ackC7o��� E�r���e�it�c�n asser��bly detailcd belo��� has been t�,«�i a��d maintaiiied ati r�qliired by 1'CI�;Q rc,�t�lati«ns aild i� ceriif�ied t<< he o�eratin��«�ithin accc�tablc p�irajneters. TYPE OF ASSE�LY c Rcduc�d Press�c Princioic � Pressurc Vacuimm Brcakcr �' �ouble Chezk ti aivc � Atmosphcrc Vacuum Brca� Manufacturc: ��.5 Size 2'` Model'titmmber �7M/ Located At t_�u��t[lt(� ���°'/'1Cw �/1O��C�`' s�;���b� �'s83� REDUCED PRESSURE PRINCIPLE �SSE:KBLY I PRESSL'RE VACUZJ'.bi BREAI+�R i Double Ch�tk v alve Assembly + � ist Chec4: 2nd Checl: Relief Valve � :�ir Inlet Check Va1ve i + Ininal Tat DC-C;os�d 2•� Close�'Ti�h[ p� Opened at Ooenat at vsid Ti�t � Leal:cd 2 Z � �sid Dsid � Rp-_,.psid r� � Leai;ed C Did not Open � L.cal:e� � �� Iand Matcrials liscd Test A.ftu DGClosed Closed Tight J Opened at Opene�at osid RG�S317 T1�1C G DSid DSld RP sid The abovc is caaficd to be tive. Firm Name HC'+tC�V1 i-�b''�1"(ZCj� Ccrtifiod Tata 1(a �n 1S7"o►rl Firm AddrGss '� � Ccrt.Testa Na. �J7��I G�S)Deu � 20 �5 l�(,4�krc 1�GC d�l.e I k" (�auge # �p���7�jr llate last accuracy tested � White - Customer's Copy Yellow - City Copy Pink-Tester's Copy CFIf�C#i UN�: IKRIGATION DQMESTIC X FIR�LINE BACKF'LOW PREVE"�'I'ION ASSEMBLY TEST AND MAINTENANCE REPORT NA.��tE OF PWS: �.� i'� C, (_' ���..(���[� PWS i.D. � LOCATIO'v OF SER��ICE: �i �'�tQVI/�Mnn�� Tl�c L��.,cklloE� ��re��entiut� �ia�embl�� detail�d belo��� ha� been t�����1 ar�d «»i�itained as required bS'�I'C1�,1,) rc«ulution�; and is c�r'CitEcd t« be ��perating ���ithin acce�tahle ��ararneters. TYPE OF ASSE:�iBLY ❑ RC�uC�PI'CSSIu'c PI7IICiDiC � Pressure Vacuum Breaker j�' Double Chxk Valve c Atmosphere Vacuum Breal.e: Mauufac:ure: Ll�(� Sizc ��' �'�d.t�1�4S�'_ COri..c r � �Y Model'vumbcr DCj�/ I,ocatcdAt �- -- Scrial:v�ber ��f��� REDLCED PRESSURE PRINCIPLE ASSE:�iBLY PRESSURE V�CU'UM BREAKER Double Check�alve Assembly � � I lst Checl: Znd Chec{: Reiief Valve :�1ir Inlet Chccic Valve � � �Iniaal Tcst DGCiosed 1�g Closed TiQhc ,� Opened at Oneaed at vsid (� Ti�t � Lcal:ed j, �p ❑ gsid osid ^ RP-spsid ' I,eaj;ed c Dtd not Open � LLc:aalced � �� I and Maurials Used Test Ai3er DC-Closed Closed Tighc o Opened at Opcned at �sid Rtpair Tight C �sid nsid RP sid 1"he abovt is catified to be true. Firm Name N['�"101� t'1b'���(ZC�S Ccatified Testc l�l� ��.tSTo�1 Firm Address 1'li,C�OX /"!� Ccrt.Testa No. �PJi��IGY?S I Dnte � 20 �5 L(,�`l SCLI l�(,�C dl LQ I)c Gauge # �p�f�'�5 llate la.st accuracy tested White - Customer's Copy Yellaw - City Copy Pink-'I'ester's Copy C�IEC,� ONE: IHRIGATION x DOMESTIC FIRELINE BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPQR? NAMEOFPWS: ���?`I G' (-1 Lc�n�r�% PWS I.D. � LOCATION OF SERVICE: �� �'QIMMnnc'� Thc backtlo«�� prevention assen�bly detailed belc���v has been tcstcd and maintained as required by"I'Cf:Q rcaulations and is certitied to be operating w°ithin acceptable pat-ameters. TYPE OF ASSEMBLY ❑ Reduced Pressure Principle ❑ Pressure Vacu�Breaktr k( Double Chxk Valvc C Atmosphere Vacuum Breal:er u Manufacturer �-�-'�Q Size � Model Number r`�� Located At �02�.S°� Cor-��^ � IN�flr $crial Nimmbcr �0�//S �b �aCi^ 7�-i�eC�G�'�'��2�� REDUCED PRESSURE PRINCIPLE:�SSE:VIBLY PRESSURE VACULJM BREAKER Double Check Valve Assembly lst Checic Znd Checl: ReIief VaIve :�ir Inlet C6eck Vaive Inival Test DGCloscd Closed Ti�t ❑ Opened at Opena3 at osid Ti�t ❑ Lcal:cd ❑ osid osid RP-_psid Lcal;ed O Did not Opcn � Leal:ed 7 �P� and Mataials Used Test ARu DGClosed Closed Tight ❑ Opened at Opeatd at vsid Repair Tight � nsid nsid R.P sid The above is catified to be�ue. Firm Name F'�'_�-tC�V1 1-iV�i"26� Certified Testa IJ�ISCm �c�ST'o�1 Firm Address 1�,t�x ��7 Ccrt.Testa No. �������Date � 20 l 5 �c k�L1CfC 61 LQ (X Gauge # �p����]5 llate last accuracy tested White - Customer's Copy Yellow - City Copy Pink-Tester's Copy CFiI�:CiC �UNl3: IHRIGA'['ION DOMESTIC FIR}'sLINE � BACKFZOW PREVENTION ASSEMBLY TEST AND MAWTENANCE REPORT NAME OF PWS: c_, i �/ C� � Lc:(�C1��� PWS I.D. � LOCATION OF SERVICE: �� �V'NMnnc� _ �Thc 1,.�ckflu�i� }�r��ention assemhl}'detailed bclo��� h�is been tcs�c�l��nd mai�lt'aiu�d as required by"CCl_,O z-c_ulution� and i� c�rtitieci t�> he �peraCin� �tithin acc��tablc p��raineters. TYPE OF ASSE:�iBLY ❑ Reducrd Pressure Princi�le _ Pressure Vacu�Breaktr �$ Double Check V al��e � Atmospherc Vacuum Brtal� Maaufac:ure: C�'d��S su� P �' Mode!'vumber �� Locatcd At NO.�i�O�f� C_•1�-r�or !/Q�•t��- Senal�vimmbcr �002�/ REDUCED PRESSUR.E PRINCIPLE :�SSE:I�LBLY ( PRESSURE V�CU[T!�I BRE.rLKER Double Check Valve Assembly � I lst Cherl: 2nd Ched: Relief Valve :�ir Inlct Check Valve a � Ininal Tat DGCiosed �•$ Closed Ti�ht �Q Opened at Opeaed at vsid Ti�t ,� Leal:ed �,(� ❑ �sid osid R:°-�psid L,cai;d C , Did not Opea � Lcal:e� � �P� and ;�iaurials li scd Test After DC-Clased Closed Tight ❑ Opened at Opcned at Dsid Rcpair Tighc C osid osid RP sid The abovc is certificd to be tzue. Firm Nazne N[��"tUV1 i�tb''C� i'(Zt�� Certified Tata ��(aSCm 1STo� Firm Address 1�"��OX /"!� Cat Testa No. �����>)Dau � 2-0 �5 �i(�l kLl�'1C���LQ �X Gauge # ap����jr llate l�st accuracy tested White - Customer's Copy Yellow - City Capy Pink-'Pester's Copy CFIECK tJNI's: iRRIUA.'d"IOIV DOhiESTIt; FIRI'sLINE � B�.CKFZ,OW PREVENTION ASSEMBLY TEST'AND MAINTENANCE REFORT NAME OF PWS: �- � � 'f C' (_ Lc.����-�« PWS I.D. � LOCATION OF SERVICE: GaV,� '�Y1/1M�1[�r►G �hc h��ckllo,�� E�re�tntio�i ass�mbl} detail�d belo��� l�ae be�n t�•,ec1 and maintained ;�s r��quired h5��['CE�(� r�,rulali��n� ,irld i� ccrtiti�ci t�� be ��E�eratin� ���itl�in <icc���l<ihlc E�ziramelers, TYPE OF ASSE:vIBLY ❑ Reduc�d Pressure Princi�ie -. Pressure Vacuimm Br�akcr � Double Check Valve �. A�nosphae ti'acuum Breal:tz 3 " htanu�`acturer �la'��'�' Sizc � Mode?'viunbtr Od 7�f/� Locatcd At /�"me�ltC�Sf' ��"(� Sc:zal N�ba ���7 Z REDUCED PRESSURE PRItiCIPLE:�SSE:�LBLY' I PRESSURE V�CUU:�i SRE.�IKER Double Check v alve A,ssembly ilst Chec1: 2nd Checl: Relief v alve :�ir Inlet Chock Valvt I` � Iniaai Tcst DC-Ciose�' 2•� Closec Ti�t '� Opened at O;ocacd at osid �� Ti�t � Lcal:cd ,Z � ❑ �sid Dsid R:°-�psid �! I Leai;cd G Ihd not Oprn � L,eai:ed � Rer�aus ! �and Matcrials Uscd Test Af�er DGCloscd Closcd Tight ❑ Opcncd at Opmad at esid Rcpair Tieht ❑ nsid osid RP sid Ihe abovc is cu�6ai io be true. Fum Name H['�"l(�Y1 t'tVL 1"(ZC�� Catified Testa l�� �n }-}( LSTo�1 Firm Address I�/.C�OX /'!7 Cat Tc.sta No. �J��IGYa..��)Date � 20 l5 (�c kcc l�G c lt� (k" �i8ltge # (.'lL//!-L�f J /�J llate last accuracy tested White - Customer's Copy Yellow - City Copy Pink -'rester's Copy c�iLcx c�x�: IRRIGATION � DaME3TIC FIRELINE BACKF�Z�W PREVENTI�N ASSEMBLY TEST AND MAINT�.NANCE REPORT NA.ME 4F PWS: �-''?`.� �`F� �'r�„��,1,�1� PWS I.D. # LOCATIQN OF SERVICE: �� ��,�,�,,,'1,�Q� Th�:backflow preventian�55e�nbly detailed belo�v has been te�ted and maintained as required by TGEQ regulation� aa�d is cer�ified to be operatin�withir� ��ceptable parameters. TYPE OF ASSEMt3LY a F.cducrd Pressurc Princinle p Pressure Vacuum Brcaker `� Danble Check Va1ve ❑ Aunaspl�Vacuum Breal�r . - �� Maaufacturcr ��:�7�C� Sizc �z�N,�� �� ���.z �c;--� �..�s�� t'0►�r�c+� �,��.-�o�. s��r���� �l"1/�� �',, C��� �� `f"urti..�a� ��'�' 1���°' REDUCED PRESSL3RE PRIl""�1GT�'LE ASSEMBLY PRESSiJRE VACUUM BREA�CER Doubte Check'�aive Pisse�nblv lst Checi� �nci Ch�ct�. Relief Va�ve !4ir Inl�i Check Vatve Initial T�st �-Closcc3 !Closed Ti�hx ❑ C}peacd at 4peaai at flsid Tight ❑ Lcal:cd ci nsid __nsid RP•_____psid Lca�:� o Did noc 4pea 0 Le� � kcp�i�rs and Matcriais u�a Tast Afrcr DC-Clt�sed Closed Tis� t o ppcaed at ppeaod at ,_nsid R,�pair Ti�hi ❑ �nsid �,___„_,psid RP sid The abova is ce�fi�ci u�b�t�ve. Fixm Naa�e,��'(c�.�q��.� C�ru�ied Tcstc ��� t-t��:'a—r�� ,(�� � Firm Address„��11��� � Cert.Trsta Na.� � Dace �__��� G��2�'���c,�Ir�. �� "��itsy`� ��"���� ��`� �C� 7� .S�n �" �� I4 c.�-�`i�., �'�, ,, � 1 � r llate I�st accuracy tested � �� � t°�;,.� ,,C 1'„�,. 7�S � y � ;- .SC�vI/l�,G� t � I,Jct �c ����i i � ���� i�Ihite�-Customer�s CoAy Yellow -�itY �aPY F'i�nk-T�ter's CoP'Y