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2015_0615 C�IECi� ONE: IRRIGATION llOMESTIC '�.1 FIRELINE BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAN�OF PWS: L��7`l G'' F L�c�l-�p�.1> PWS I.D. # LOCATION OF SERVICE: �I�I`� S• Q�y c i Thc backflow prevention assembly detailed belo�� has been testcd and tnaintained as required by TCEQ regulat�ions and is certified to be operating within acceptable p��rameters. TYPE OF ASSEMBLY � Reducrd Pressure Principle Q Pr�ssure Vacu�mm Breaker � Double Check Valve ❑ Atmosphore Vacuum Breal:er Manufacturer I�:l K��i Size �' Modei Numbtr �.`.�v Locaud At �J 5:1 C � S 7'<�t i Scria[Nimmbcr a� 1 ',�5�c4� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V�CLTUM BREAI�R Double Ch�ck Valve Assembly lst Check 2nd Checl: Reiief Valve :�ir Ialet Check Valve Ininal Test DGClosed Closed Ti�ht � Opened at Opened at nsid Ti�t � Leal:ed ❑ osid nsid ��tis RP- �� Dsid �� Lcal;ed o Did not Opea O Leal:ed o �P� and Mata-ials Used Test After DGClosed Closed Tight o Opeaed at OQcaod at nsid Repair Tight o �nsid osid R.P sid The above is certified to be�ue. Fum Name�Cn�� n �':•-e- Certifiod Testa 1_�tJe�� W�.�� — Firm Address �a �� S 7 Cat Testc No. c�c� 9zl J+' Date / '� ��.� �� Gauge # Q3��3 r'� llate last accuracy tested jJ g� White - Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IEC� ONE: IRRIGATION DOMESTIC 1� FIRELINE BACI�LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REpORT NAME OF PWS: _ L r ?`I G'� � �r,(�IJ _ / PWS I.D. # LOCATION OF SERVICE: `I y� J�• ��1�t Thc backflo�k� prevention assembly detailed below has been tested and maintained as required by TCEQ re�tilati�ns and is certified to be operating within acceptable pat•ameters. TYPE OF ASSEMBLY ❑ Reduc�d Pressure Principle a Pressure Vacuimi Brtaker � Double Chcck Valve ❑ Armosphere Vacuum Breaker Manufac�urcr �t L Cav+ i Siu � Model Ntmiber 3 5 C� Located At J�. ��C. � ,5 i f e�c � Serial N�ber � �.3'� � 7 c� REDUCED PRESSURE PRINCIPLE�ii.SSEMBLY FRESSURE VACU'LTM BRFAKER Doubie Chetk v alve Assembly lst Cherl: Zad Checi: Relitf Valve :�ir Inlet Check Valve Initial Test DGClosed Closed Ti;ht � Opened at Opened at nsid (�_ �5 Ti�it o�c� 8� Leal:ed,-��, ❑ _�sid __nsid —�- f-^�' RP-_psid Lcai:ed O Did not Open ❑ Leal:ed ❑ �P� and Materials Uscd Test ARer DC-Closed Closed Tight o pp�� Qp��at nsid �P� T�� __psid _�osid —� RP sid � _. The above is certi.fied io be�ue. y 5 .. . ...,"...,,.,�. � � � W..• �/��. � . , /" � Firm Name A� r�..,,� (_`,;�� o ' C ' I`ester It� y h� W�-h�,, �� •5 (� _. _,....,,. L-� �I Firm Address r� �'x 7 S 7 Cert. Testa No. �Xx>�1��5. Date��T��' �.tis'� �c.�Xa v��,.t v►•c �'� %'��i l.t� Gauge # D S t�S -- 1�; llate last accuracy tested 3��1� White - Customer's Copy Yellow - City Copy Pink-TesteNs Copy C�IECK t�NE: IRRIGATION_�_ DOMESTIC FIRELINE BACT�LOW PREVENTION ASSEMBLY TEST AND MAIIV'I'ENAN�'E REppRT � NAME OF PWS: �.r�?`/ L'� F� (G�n p 1 PWS I.D. # LOCATION OF SERVICE: `�`I.� j. !�,cay o l Thc backilo��prevention as�embly detailed belo«� has been tested and maintained as required by TCEQ regulations and is certified to be operatin�within acceptable parameters. TYPE OF ASSEMBLY ❑ Rcduc�Press�e Principle C Pressure Vacumn Breaker '�'� Double Check Valve ❑ Amiosphac Vacuimm HreaL-er Maztufactiucr WG`► T � Siu �' Model N�ber l�`?w► 1 Located At �. S�cl� � G �u��G �+ L�T/:�h�r s��r;�b� b 5�� REDUCED PRESSURE PRINCTPLE:�.SSEMBLY PRESSURE VACUiIM BREAI�R Double Cherk Va1ve Assemblv lst Checf: 2nd Ched: ��{y�e °r Inlet Check Valve Iniaal Test DC-Closcd Closed Ti;ht ,�i Opencd at Opened at _nsid Ti�t��c7 �9 Leal:ed I ❑ _ nsid _�nsid ��'� R.P-_,psid � �� Did not Open � L,eal:ed ❑ �� and Mataials Uscd Test After DC-Clased Closed Ti�t o ppm�ai ppm�at nsid Repair Tight o __`Dsid osid R.P sid ?he above is cera.fied io be�ve. y.�5 Firm Name��-T rc•r� F'�:z- Catified TestQ _ W�7 v.e ��v.w ��- Firm Address �c� �,°'� cj Cat Tesur No. ��n�l�l�l 5� Date �I��`I a� �C.c•�,�. �� '1Sl�i`v Gauge # Q��9� �a ) � llate last accnracy tested 3f/"� White- Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IEC� ONE: �y �c, s 5 IRRIGATION DOMFSTIC FIRELINE �J ��C� BACI�LOW PREVENTION ASSEMBLY TEST AND MAIIV I'ENqNCE REppR? .� NAME OF PWS: �.��?� G'' F� G� _ � PWS I.D. # LOCATION OF SERVICE: `'l`I� �• Q�a G c Th� backflow �revention assembly detailed below has been testcd and maintained as required by TCEQ re�ulations and is certified to be operatin� within acceptablc parameters. TYPE OF ASSEMBLY Q Redur.,�Press�e Principle � Pressure Vacu�Breaker �'' Double Chcck Valve ❑ Atmospherc Vacuum Brealer Mauufacturer 1JJ� �z � Siu -'3�`� Model iv�ber 1��1 w� � Located At tllr`�QT. 11r�� i Scrial Iv�bcr � �G+r� � REDUCED PRESSURE PRINCIPLE:�SSEMBLY FRESSURE VACUiTM BREAI�R Double Chtck Valve Assembly lst C3ec1: 2nd Chtcl: Relief Valve :�1ir Inlet Check Va1ve Iairial Tat DC-Closad Closed Ti;ht � Opencd at Opened at _�sid Ti�t�-c� 8P Leal:cd ,�� 0 ❑ __`nsid ___�osid pc y 5 RP-_�sid �� o Did not Opca ❑ L,caked O �� and Matcrials USCd Test Aftar DGClosed Closed Tight o pp�� Qpm�at _�sid Repair Tight o _�flsid _,nsid RP sid The above is certified io be�ue. �i.r S Firm Name .��;rn�„ F'•L Certified Testa _ t��c ��►n a� Firm Address�� 7 7 Cat Testa No. C��0 9�1 a� Date l�� '� or��.�4��.,�� '1Sif�� Gauge # _rj3G��c�,�1.3 llate last accuracy tested 3/��/ White - Customer's Copy Yellow - City Copy Pink-Tester's Copy C,�IEC� t�NE: IRRIGATION DOMESTIC FIRELINE ;•� yV�r,, ✓� BACT�LOW PREVENTION ASSEMBLY TEST AND MAINT'ENANCE REPOR? NAME OF PWS: �.�'?� G' � c, _ - � -- � n�r�/` � PWS I.D. � LOCATION OF SERVICE: `�`lr 5 •S . lC r,�l c: L The b��ekflo�k� prevention assembly detailed below has been tested and maintained as required by TCEQ regulations and is certifiec� to be operating within acceptable pai-ameters. TYPE OF ASSEMBLY ❑ Rcducrd Pressure Principle � Pmsure Vac�n�Breaker � e Amnosphere Vacuum Breaker A Ae !)h Manufacturcr i�1 c,�' s S Siu D Model lvumber 7 (� � Locaud At �� ;�� ► s��N�b� i b �"7 3 REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACtTUM BREAI�R Double Check V alve Assembly lst Checl: Znd Checl: Relief Valve Air Inlet Check Valve Ininal Test DC-Closed Closed Ti�ht �D Opened at Opened at nsid ��S� Ti�t� ,� f�' Leal:ed �.� ❑ asid nsid _� R.P-__psid --` �� o Did aot Opea O Leal:ed ❑ �� and Materials Uscd Tcst ARer DGClosed Closed Tight o pp��at Opcaed at osid Repair Tighc o i�Dsid _nsid RP sid Tht above is certi.fied to be�ue. ,�,�� Firm Name �� _+�-,^ �'>•�- Cectified Testa �Wo.��z_ W`��v� �� Firm Address ��'t 7� � Cert. Tester No. �C��9`1 a 5 Date � 1�)1` XG Y`L'C�v1•� ��`� 1�{�� Gauge # �3 v,S��l�� llate last accuracy tested 3 I��' White - Customer's Copy Yellow - City Copy Pink-T�ster's Copy C�IEC� ONE: IRRIGATION DOMESTIC �O FIRELINE BAC�LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REppRT' l NAME OF PWS: ��T�/ � �' �G�n n�-j� PWS I.D. # LOCATION OF SERVICE: `�� - �u�c� The backf]o��prevention assembly detailed below has been tested and maintained as required by TCEQ regulations and is certified to be operating �vithin acceptable pai•ameters. TYPE OF ASSEMBLY ❑ Reduc�d Press�e Principlc e Presstve Vacu�Breaktr �'Q Double Chxk Valve ❑ Atmosphcrc Vacu�mm Breaker Manufact�er W i L Y�w 4 Siu v� Model Nt�ber 3 5� Located At '�J, S�d� G� S i f'c c = s��N�b� .A + 3�q8'F REDUCED PRESSURE PRINCIPLE:�.SSEMBLY PRESSURE VACUfJM BREAI�R Double Chetk v alve Assemblv Ist Checl: Znd Checi: Relief Valve Air Inlet Checic Valve Initial Test DC-Closed Closed Tight �'r Opened at Opened at nsid Ti�t ;3�� IaT+ Leal:ed�� ❑ _,nsid nsid �l�`�y RP-_,psid I-eal►ed � Did aot Opea O I,eaice� ❑ �P� and MateriaLs Uscd Tcst ARer DC-Closed Closed Tight ❑ Openod at Opeaod at _�sid Rcpair Tight o ,,,_^nsid nsid R.P id The above is catifiod w be uue. �/{� Fum Name�C;r�•n F��G Certified Tester �t��, r W N h v�+� Firm Address �� 'z 7�i 7 Cert.Tester No. �c�[��i�l a S D� l�J/c �d�Ch��4 h�+' J �' �� Gauge # D�p�� y� llate last accuracy tested 3!H White - Customer's Copy Yellow - City Copy Pink-Tester's Copy