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2014_0724 CfI�CK t�NE: IRRI+GATION�� I?O�ESTIC � FIItELINE BAC�CFLOi�FRE'VEN'I'I+dN ASSEMBLY TEST AND MAIIV'I'ENANCE I�POit? NAME C1�PW5: ���?`�_,�e��L3�1 PWS LD.# LOCATION OF SERVICE: Sprouts#108 110 W. Sandy Lake Ln. The backilc7w preventi�n assembly detailed belc�w I�as b�en t�sted and maintained as required by TCEQ re�ulatit�ns and is certified to E�e operating within acceptable p�rameters. TYPE OF LY Ral�zd Pressur�Prin�eiple P�ressure Vac�uu�o Brealaer �/ Double Checic Vai�re A�aosph�rt Vacuum Bresixr ���.�� Wilkins $� 2" �����, 550 ���t Fire pump room ���N��. W16469 REDUCED PRESSUR�PRI�iC�PL�ASSEMBLY PRES�URE V4CUUM BR�AKER Double Check V��ive Assem6lp ist Check 2nd Check Relie�'VaIv�r �ir 3nkt �►�cic Vaive iaitial7est DC-Clascd Closed?i�ht U�ted at 4p�d at nsid g5� 7ig� Leal:ed �tisid _____��id x�-3, I 3,v . � I,eal+od Did not � D � � '�P�n F.�Pairx aud Maurials Usad Test After DC•C�vsed Closed Tis,�t � ppcaed,at ppcc�at ,�sid x�� r��nc ❑ .��a �a R.P' "d The�bove is certified to be t�n�e. ���� Action Fire Pros ��T� Allen Stevens ��A� PO Box 797 Waxahachie G�Tc�c,Na. BP0009860 � 7-24-14 ��„�� � 07090476 l]�ate tast accura� tested 9-27-13 White--Customer's Capy Yellow -City Copy Pinlc-Tester's Copy