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2014_1009 (2) C�IBCK ONE: IR.RIGATION � DOMESTIC FIftELINE BACKFLOW REYENTION ASSEMBLY TEST AND NANCE REPORT �o e �S e►-v l'c� rr�oF Pws: f'� �/ .� 5 Pws I.D.# , LOCATION OF SERVICE: I ��� rQ� �Y ��✓ The bacl�low preveation asscmbly decailed below has been tested and maiataincd as required by TNRCC regulanons aad is ccdfied to be operating withia acccptable parameters. TYPE OF ASSEMBLY ❑ Reduced Pressure Priaciple ❑ Pressure Vacuum Breaker � Double Check Valvc ❑ Atmosphere Vacuum Bnaker t � ��T'1"`� Size Zr� Maaufacturer Model Ivumber W7 � I � Located At �� O� � G Serial Nianber � � ��� `�� �� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUIJM BREAI�R Double Cherk Valve Assembly lst Checl€ �� 2nd Checl:�� ��{��ve :�ir Inlet Check Valve • Inidal Test DC-Closed Closed Ti;ht o Opeaed at Opened at osid �l Ti�ht ❑ Lc�l:cd o psid osid f RP-_�sid Q� L,eal;ed a Did not Opan o Lealced o �� and Materials , Used Test After DGClosed Closed Tight o Opened at Opeaed at �sid Repair Tight o �sid _osid RP sid The above is certifiod to be true. Firm Name � � � � �S T� . Cerdfied Testa�'6 ��� � I � Fi:m Address � ���`^'t'Q►�1�1 �� Cert.Tes�er No. ��`��� Date I b � /� Gauge # 7iS��� llate last accuracy tested � � �� White- Customer's Copy Yellow - City Copy Pink-Tester's Copy - C�IECK ONE: IR$IGATION ✓ DOMESTIC FIRELINE BACKFLOW PREVENTION ASSEMBLY TEST AND MAIN'I'ENANC'E ItEppRT NAME OF PWS: �a P�P�I� -�-5� �'�JJ j CQ- `..,�t�`r1"� PWS I.D. # LOCATION OF SERVICE: 13�� �ra� '�� r,✓ �, The bacl�low prevmtioa asscmbly desailod below has beea usted aad maintained as require� by TNRCC regulanons aad is certified to bc opera�ng withia acccptable paramcters. TYPE OF ASSEMBLY ❑ Reduced Press�e Principle ❑ Pressure Vacu�Breakcr t� Double Chcck Valve o Amzosphere Vacuum Brea�er • � . �,, Manufact�er �-eb Sizc Model Number � �� Located At �`��� �� " � C'' Serial Nimnber � � � I� ��� ., { � REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACiTUM BREAI�R Doubie Check Valve Assembly lst Che Z i3 2nd Checl:Z��- Relief Valv� :4ir Inlet Check Va1ve � Iniaial Test DC-Closed � � � Clos�d Ti�ht �D Opeaed at Opened at osid � Ti�i 'p� Leal:ed o psid __„�sid � RP-_,psid Leal:ed 0 Did not Open o I,eaked O �� aad Materials Usod Test After DGClosed Closed Tight o Opeaed at Opened at _�sid Rtpair Tight a _osid osid RP sid The above is cerdfiod to be true. Firm Name� PI I ��p Certi,fied Testa �G U!�q � 1 r � !\ � Q �f Fi�m Addrcss I�0� t�ro� �" '� Cat T'ester No. ��5v Date �a c1 �% Gauge # �� Qn� llate last accuracy tested / � t � White- Customer's Copy Yellow - City Copy Pink-Tester's Copy r CFIBCK ONE: IItRIGATION �/ DOMESTIC FIRELINE BACI4'I.OW PREVENTION ASSEMBLY TEST AND MAINZ'ENAN(�REppRT NAME OF PWS: `..££)(�P�I I .1- S� �U I C,�'- C.,�I'h'r"�J'" PWS I.D.# LOCATION OF S1�ItV�CE: 3 f(,�1'1 E� �t�' � The baci�low p�eation assembly detailed below has been tested aad maintaiaed as requind by TNRCC reguladons aad is certified to be operating within acccptable parameteis. . - TYPE OF ASSEMBLY ❑ �educed Pressure Principle o Pressure Vacuum Breaktr � , � Double Check Valv� o Amzosphere Vacuum Breaker Maaufacturer ��p�� , Size ��� > Model Number ��� Locatad At /�O�l. �t�(� Seriai Nimnber '� a�A t � � REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER Doubi�Check Valve Assembly lst Che 'Z,� 2nd Checi: 2,'j ��f Valv� Air Inlet Checit Valve °� Ynirial Test DGClosed- Clos�d Tight � Opeaed at Opeaed at �sid , � Ti�t � Leal:ed psid _„osid + �a RP-_psid �� Leal:ed o Did not Open o I,eal:ed o �P� and � , Mataials Used Test ARer DC-Closed Closed Tight o ppeaed at Opcaed at _nsid Repair Tight 0 ,_��sid ' osid RP sid The above is certifiod to be tirue. , Fum Name � � Ca�tificd Tcster �� ' Firm Add�ss V� V' Cert. Tescc No. ����Date �� T Gauge # �� llate last accuracy tested � � r� White- Customer's Copy Yellow - City Copy Pifik-Tester's Copy %