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2015_0724 CFIECk� UNL: I1�RIGA'I'ION DOMESTIC FIRELINE �'� BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME �FPWS: �--���`I C'' (� Lc•�f���1� PWS I.D.K LOCATION OF SERVICE: �`�e�cGS ��,�e� n�c-I-i t�r'�t I �c�IG� LN�ZoC? r��j_r, � � Thc t�acklli>��� pre��ention assembly detailed bclo��� has been tc�stccl �nd maintained as required by TCEQ rc��rulati«ns and is certificd tu be o�eratin�=«�ithin acce��table paraineters. TYPE OF ASSEMBLY ❑ Reduced Pressure Principle ^_ Pressure Vacuimm Breaker j'� Double Chcck Valve � Amzospherc Vacuum Breal:er Manufac�urc: �� Size �� Mode:�i�nber C/=� Located At �;�'t�c�� l� ,t��[-f�s l� Se:ial N�ber C(�1�'l�7da�lr REDUCED PRESSURE PRINCIPLE:�SSE:�iBLY I PRESSL'R.E VACCTUM BREe�R Double Chetk Valve�issemblv Ist Chec{: Zad Checl: Reiief v alve :�ir Inlet Cheek Va1ve Iuiaal Tcst DGClosed 3.� Closed Ti;ht �' Opcned at Opened at vsid Tibht $° Lcal:cd 2 r� ❑ psid osid RP-_____psid L.eai:ed C Did aot Opea o Leai;�d o Rep airs and Maucials Uscd Test ARer DGCloscd Closcd Tight o ppened at Opcncd at nsid Rtpair Tight ❑ osid asid RP sid The above is cati6ed to be true. Firm Name�L-1-�o rt �ir� �Lo5 CcrtiSed Ttsta \Ir.2SrsY� �,t��S r v�� Firm Address ���c�� ��1 Ccrt. Testet Na�h'��21 CXd�t Date L� � 11.�axali;G_C�n 1� 1� Gauge # l�lv/ioo�t� llate last accuracy tested q � White - Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK ONE: � � � IRRIGATION DOMESTIC FIRELINE � BACI�LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPOR? NAMEOFPWS: �.��?�I L� F� c-np�.« PWS I.D. � LOCATION OF SERVICE: �e�'S ��n-1er nc�-�,n�ia l 5£�5 S. �2v�) ��10� The backtlo���prevention assembly detailed below has been tested and maintained as required by TCBQ re�;�ulations and is certitied to be operatin��vithin acceptable parameters. TYPE OF ASSEMBLY � Reduc�d Pressiae Principle ❑ Pressure Vacu�Brcdker � Double Chxi:Valve C Aunospherc Vacuum Breaka Manufacturer �i"✓�S Sizc Z" Modei Number ��G'�� Locatod At C ��i�l vrq 1j�r �,��i�5' SerialNtmiber C��� �-lvr�i�r=�.�z�r_ %o� REDUCED PRESSURE PRINCIPLE ASSE'.�IBLY PRESSURE V�CLTUM BREAI�R Double Chetk Valve Assembiy lst C3ec1: 2nd Checl: Relief Va[ve Air Inlet Check Vaive Ininal Test DGClosed /4.D Closed Ti;ht ,�(S Opened at Opened at osid Ti�t .� Leal:ed 9� ❑ 3•� psid nsid RP-_psid Lcai:ed o Did not Opea o Leal;ed ❑ �pa;rc and Mataials Used Test ARer DGClased Closed Tight o Opened at Opcaed at �sid Repair Tight o nsid vsid R.P sid The above is cerafie�to be�ue. Fum Name�L�or� �ir� �LoS Certified Tes�r _'LlL�Srs►'► �iv�i�r� Firm Address �O�5c�u -T�1 Cert.Tester No. I��ZL71�1 Date Z� 5 �iO,XGtL�lG C1�,t�Tx Gauge # ,��,!�o��15 llate last accuracy tested White - Customer's Copy Yellow - City Copy Pink-Tester's Copy c�i�c�s urr�: iRRIGATION DOhiESTIC FIRELINE � B�iC'I�'LOW PREVENTIQN ASSEMBLY TEST AND MAINTENANCE REPORT NAME QF PWS: �! l, C' l� Cc•:���r_�/ PWS I.D.# LOCATION OF SERVICE: �`�Ex�i'S ��r�-4e r n��,o r'�cc I ��r� �� ��'HG� L_Iv�2oc? Th� backilo��� pi-e�-eiltion as�embly detailed bclo�t� has been tc��[ed and �naintaitted as required by TCEQ rc��ula�ion; �3nd is certifiied to 'l�e oper�tin�.* «�ithin acce��tc.�ble parameters. TYPE OF ASSEiv1BLY ❑ Rcduc�d Pressure Princi�le � Pressure Vacuum Breaker �d Double Chxk Valve � Amiosphere Vacuum Breal:a Manufacnucr �e�cn Sizc 3��� Model'_v�ber �`�� L,ocated At Fire��u I�- .�u�-�5�.� Sc:ial Niunber L>Z�'L2 REDUCED PRESSURE PRI?+1C'IPLE:�SSE:��LY I PRESSU'RE V�C[JL1M BRE�iF�R Doubie Check�alve P►ssembiv lst Checl: 2nd Checl: Relief Valve :�ir Inlet C3tck Valve Iaiaal Test DGClosed /,� Closed Ti;ht q� Opened at Opened at �id Ti�t !� Leal:ed %,� ❑ psid osid RP-_psid L,cai;ed ❑ Did not Opea ❑ Lea1;e� ❑ �P� and Maurials Uscd Tcst After DC-Closed Closed Ti.P�ht ❑ Opcned at Openad at osid Repair Tieht D �sid osid RP sid Thc above is carified to be true. Firm Nama�L-ho r� �ir� �Lc+5 Certifial Tuta \!�'iSaY� �,'c�s r v�t Firm Addrrss ���c�x �`�1 Cert. Testcr No.�h'��Zb I CXo�( Date -' Z� .�� WaxaLtc�Lln 1� i� (lauge # (���roLy7� llate last accuracy tested � White - Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECY� UNL: I#�RIGA'I'iON DOMESTIC FIRELINE � BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: �-�?;� C'' (� Lc�(�l��r/ PWS I.D. # LOCATION OF SERVICE: ��E_�5 �n-4e r n a�-�n r� I ��r� j� ���,�) L�r�2�� Thc harkllo��� pr��ention assemhly detailed bclo��� has been tratcd and maitltai��led as required by TCEQ rc�rul�ition� and is certiti�d tc� be operatin��1�ithin acecptable p�irameters. TYPE OF ASSEMBLY ❑ Reduced Pressure Principie � Pressure Vacuum Breaker � Double Chcck V alvc � Atmospherc Vacuum Breal:tr Mauufacture: �D{,✓a Size �1�� Mode:'v�ber �.�n` Locateci At �r,e f/�tu�� ���.,-�l�stc� Serial?v�ber �'J3p�/2%lo/S� REDUCED PRESSURE PRINCIPLE ASSE:�iBLY � PRESSL'RE V�CIT[JM BRE�R Double Check v alve?►ssembiv lst Chec1: 2nd Chec.t: Reli�f Valvt :�ir Inlet Chock Valve Ini�al Test DGClosed �.� Closed Ti;ht �c" Opened at Opened at nsid Ti�t ,P� Leal:ed 3 Z ❑ �sid �osid RP-epsid Leai;ed ❑ Did not Opea o Leal:ed ❑ �pa,rc and Materials Uscd Tcst A.ftcr DC-Closcd Closcd Tight ❑ Opeacd at Opca�d at nsid Rcpair Tight ❑ _�osid nsid RP sid The above is certified to be true. Firm Name�L-1-�o r� �ir� �Lc+5 Certified Testa \I�7Sbr► �1 u�i v r� Firm Addr�ss �O�J�u �Z�1 C«t Testcr No.�t'��?I�( Date Zf .� Waxc�L;c�C�n�� i� c�auge # _ .��r o c��I 5 llate last accuracy tested ' W'te - Customer's Copy Yellow - City Copy Pink-Tester's Copy (:tIEC� �NE: IftRIGA`fI01� � DObiESTIC FIRELINE BAC�'L�W PREVENTION ASSEMBLY TEST AND MAINT'ENANCE REPORT NAMEOFPWS_ ����� C'' r Lc���1 P�h'S I.D. � LOCATIOIv OF SERVICE: h c x�5 ��-�e r n a�,n r�t � �R� �� ���Hcc) l—ne'�2c.�c? Thc l�..ck11���1- E�i-e��e;ntion asse�nbl}' detailed l�elo��� has been t��[cd and maintaiiled as required by TCEQ rc,�ulation; and is certi�ti�d te> be operatin�� �i�ithin accept���blc p�irameters. TYPE OF ASSE.�vIHLY c� Reduced Press�e Princrole � Pressure Vacu�Breakcr ;�' Double Chcck Valve � Atmosphere Vacuum Breaker Manufacnue: �,�X� Size Z.'� Mode!'_v�ber � Located At (� j2t�ft✓' /lor�-�i�J"/�e Senal N�nbcr /3//O REDUCED PRESSURE PRINCIPLE ASSE�iBLY � PRESSURE VACULJM BRE�R Double Check�aJve�►ssemblv lst Check 2nd Checl: Reiief Valve :�ir Ialet Check Vaivt IniBal Tcst DC-Closcd Z:� Closcd Ti;ht !� Opcned at Opened at osid Ti�t ,�,'' Lea}:ed �,p ❑ psid osid RP-_.psid Leai:ed C Did not Opea o Lea};ed o Repairs � and Mataiais Uscd Test Af�er DGCloscd Closcd Tip,,ht ❑ Oppned at Opcaed at nsid Rtpair Tieht ❑ osid nsid R.P sid The above u certifi�d to be tnse. Firm Namo�L-1-�or� �irrc �iL�S Ccrtified Testa \�r.�SbY� ��vs i v r� Fum Address �O FJo�t 7`{1 Ccrt. Tesia No.t'��ZX??I CYo�1 Datt Z� � W�xali;C.�C1n1�1� Gauge # ('?�;!i O G�T� llate last accuracy tested ' White - Customer's Copy Yellow - City Copy Pink-Tester's Copy t;tIEC� UNL: IHRFGATIOI� k� llOMESTIC FIRELINE BA�Ck'F'LOW PREVENTION ASSEMBLY TEST AND MAINTEI�IANCE REPORT NAME4FPWS: �-��� L�' � Cc--►'�pr!/ PWS I.D. n LOCATION OF SERVICE: �����5 �✓�-le r n a�-�n��t I SRS �. ��c.�.�) Llv�2c� Ti�t i,�ickil����� pi-z��enti�m asscmbly detailed b�lc���� has been tc�.cci a��d mairitained as required by TCEQ r���ula�ic��1s and is �ertiti�d t« be o�erating«�itl�in acce�tabl� pzirameters. TYPE OF ASSEMALY ❑ Rcduc�Pressure Princinlc = Pressure Vacuinn Breakcr � Double Chcck Valve � Atmosphere Vacuum Breab:er Manufacturer FQ�D Size �u Mode:'_viunber �� I,ocated A: (rl'IqC�•�tor� �ju � y�i(,��Ci'' SezialN�unba �/3�78 REDL'CED PRESSURE PRINCIPLE:�SSE;l�LY I PRESSL'RE V�CULTM BREe�I�R Double Check v alve Assemblv lst Checic 2nd Checl: Reiief Valve Air Inlet Check Valve Ini�al Test DC-Closed �..f! Closed Ti�ht � Opened at Opened at nsid Ti�i .'� Leal:cd Z_2 ❑ psid osid RP-_____,psid Leai;ed c Did not Opea ❑ Leal:ed ❑ Rcpairs and �faterials Uscd Tcst ARer DGCloscd Closcd Tight ❑ Qpened at Oprned at nsid Rcpair Tight ❑ �sid osid R.P sid The above is cc-tified to be true. Firm Name�C_.�-to r� �Ir� �Itt�S Ccrtified Tesur \�G��r� �i�S r v r� Firm Address ���G� ��� Ccrt. T�No.�1'��i C�1 Date�L..� U�J�XU li;C'cCln l� 1� t3auge # l'?lv/�GU—t� llate last accuracy tested � White — Customer's Copy Yellow — City Copy Pink—Tester's Copy C�IEC� UNL: IKRIGATION DOMESTIC FIRELINE � BAC�°LOW PREVE�T'I`ION ASSEMBLY TEST AND MAINTENANCE REPOR? N.AME�FPWS: �� �`l C} F1 Lc--(��r_�� PWS I.D. n LOCATION OF SERVICE: �.��5 ���-4e r n a-I,o�� I 7£'�� �• ���,�{) L�v�2c� Th� l�ackilo��� pre���ntioi� assembly detailed belc���� l�as been tc�tcd and maintained as required by TCEQ i�c;�ulations atld i, c�rti�tieci to be opei�atin�r w�ithin acce��tabl� p��rametei-s. TYPE OF ASSEMBLY ❑ Reducrd Pressure Princrole � Pressure Vacuznn Breaker ,'� Double Chcck Valve � Amiospherc Vacuum Breal:er Manufacturer �G�� Sizc ���� Mode:'_v�ber �� Locatcd At �re�tu h� Al�r-N�St�e s�a�?�►�bc: ��v�rea�ichl� REDL'CED PRESSURE PRINCIPLE ASSE�IBLY I PRESSURE V�CULTM BREAKER Double Check�alve r�ssemblv lst Chec1: 2ad Checl: Relief Valve �►ir In1et Checic Va1ve Inival Tcst DGCPos�d �8 Closcd Ti;ht A'� Opencd at Opened at nsid Ti�t � Leal:ed /� ❑ psid osid RP-�_..psid Leai;ed c Did not Open ❑ Leal:ed ❑ Repairt and Maurials Uscd Tcst Afttr DC-Closcd Closcd Tight ❑ Opencd at Opcaed at nsid Repair Tight o nsid osid RP sid Thc above is cerrified to be u�ue. Firm Name�L��o r� �ir� �L�S Catified Testu lI i.�Sbr► �1 c�s i o�� Firm Addross �O�o� ��1 Ccrt.Tester No.�t'��I�rf�( Date Z� 5 1lvaxv,L;C'c C1�1{ T� Gauge # (��;��Oc'-7� llate last accuraey tested White - Customer's Copy Yellow - City Copy Pink-Tester's Copy