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2015_1118 CFiECK ONE: IRRIGATION DOMESTIC FIRELINE BAC�'LOW PREVENTION ASSEMBLY TEST AND MAINT'ENAriCE REppR? NAME OF PWS: d PWS I.D. � LOCATION OF SERVICE: _ c� rn - The backflow prevention assembly detailed below has been tested and maintained as required by TCEQ regulations and is certified to be operating within acceptable parameters. TYPE OF ASSENIBLY ❑ Rcduc�Pressurc Principle � Press�Vacuimm Brcaker � Double Chxic Valve ❑ Atmosphere Vacuum Breaker Manufact�er inl �►\`���r� � Siu _l_��� Model Ntmmber _ �� n � �t Located At �/a cn I-1- So f���. 1=a,.��- �'�,r n r r n�° 1�1� Serial N�ber /1��_'�O i� REDUCED PRESSURE PRINCTPLE ASSEMBLY PRESSURE VACULJM BREAI�R Doub[�Checic V alve Assembly � lst Checl: 2nd(�ecl: Re{l�{Va�ve Air Inlet Check Vaive Inirial Tcst DC-Closcd Closed Ti�t Opcn�at Opcned at nsid � Ti�t Lcal:ed ❑ osid _�osid ��Ifj RP-�sid Leal:cd ❑ 3 ' 6 Dia noc Opca a I.eal:cd ❑ �� and Materials Used Tcst Aftcr DC-Closed Closed Tight ❑ Opcaed at Opcaed at �sid Rtpair Ti�t ❑ _flsid __nsid R.P sid The above is cerri.fied w be true. � Firm Name G'i f £ `� ' v�c.�� Certified Testet P�t' �D5 ,} - ^ Firm Address�;� �+�'•���sS �j�`� - r� Ccrt.Testa No. �al3�G� Date '/�%s ��a�tv Gauge # �1 j��p�.�� Date last accuracy tested - � � White - Customer's Copy Yellow - City CoQy Pink-Tester's Copy . C�iEC� ONE: IRRIGATION � D OMESTIC g�{�J,�Jg BACI�'LOW PREVENTION ASSEMBLY TEST AND � CE REPORT NAME OF PWS: PWS I.D. � LOCATION OF SERVICE: �3O S- ��y�'t, L�i . The backflow prevention assembly detailed below has been tested and maintained as required by TCEQ regulations and is certified to be operating within acceptable parameters. TYPE OF ASSENiBLY ❑ / Rcducrd Press�c Principle ❑ Pressurc Vacu�mm Brcakcr � Double Chcck Valve o Amzosphere Vacuum Brealccr Manufac�er 'l'_CJ Size �� ModeiNt�ber �> .� LocatedA �rn�� W�Si' jrd�.pF �I� b� ✓aul�- Serial N�ba ���_�5 fl REDUCED PRESSURE PRINCIPLE ASSEhiBLY PRESSURE VACUUM BREAI�R Double Check v alve Assembly lst Checl: ?nd Chec1: �t{Va}�,e Air Inlet Checic Valve Inival?cst DC-Closcd Closed Ti;�ht Opcned at Opened at �sid Ti�t Leaked � Dsid Dsid ��y5 RP-�sid � / Lcal.ed ❑ � (� I}id not Opcn o LeaI.�d ❑ �P� and Materials Uscd Tcst Af�er DC-Closcd Closod Tighi ❑ Opcncd at Opmed at esid Repair Ti�ht ❑ �sid osid RP sid The above is ccrtified to be�ue. � r ( FirmName :�c��i�e�Jr�+eT ��` � CertifiedTesta Cut` c�D3 Firm Addre.ss�`��G,�r��55��+lef- ��SS Tf� Cert Testez No. 1�0 � Date � - ���� Gauge # Q 3���-�23 Date l.ast accuracy tested �-�-�-/� WhitP - (`nstnmPrfc C'.nnv YellOW - CitV CODV Pink -Tester's Copy C�iEC� t�NE: IRRIGATION DOMESTIC � g IRELII�TE BACI�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REpORT NAME OF PWS: c� PWS I.D. � LOCATION OF SERVICE: J�3� S- I� cti( �I�t- The backflow prevention assembly detailed below has been tested and maintained as required by TCEQ regulations and is certified to be operating within acceptable parameters. TYPE OF ASSIIviBLY ❑ / Rcducrd Pressure Principle � Pressure Vacu�Brcaktr l� Double Chcr,�Valve ❑ Armosphere Vacuum Breakcr 1. i� Manufac�er W��Il.� r�S Size 3 Modei Number 3� � Locaied At 1��rn I f _��v��� 1'�S+ C ol'n P� t�t� �'d Serial Nimmbcr J y-.�S �S REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Chetk Valve Assembly lst Cherl: 2nd Checl: Relief Valve Air Inlet Chetic Vaive Ini�al Test DC-Closcd Closad Ti;ht Opcncd at Opened at nsid � Ti�s Leal:ed ❑ osid nsid 1 �j�/ RP-�,�psid � Lcaked ❑ �� 6 Dia noc Opcn o L.cakcd o �P� and Materials Use� Tcst Af3er DC-Closcd Closcd Tight ❑ Opcncd at Opencd at �sid Rcpair Tight ❑ nsid osid R.P sid The above is ccrtified to be true. Firm Name�'�' `- �`��� �'�-- Certified Tatc ,�r i� Firm Address����Lt�-�w eyf ��v - �.c<r i ,�Cert Testa No. �g0 �y Date � "/ ���/�^ '�f/�c yi3 Gauge # o}�})(7�,2�j Date last accuracy tested � ",�'��/� Whitc� - ('.nstnmPric rnnv YP�OW - C1tV CODV Pink— Tester's Copy C�iEC� C�NE: IRRIGATION DOMES�lC FLRET,TN� BACKFLOW PREVENTTON ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: C�n�lf��� PWS I.D. � LOCATION�F SERVICE: 3��J S - �,a`I�. �_r� . The backflow prevention assembly detailed below has been tested and maintained as required by TCEQ regulations and is certified to be operating within acceptable parameters. TYPE OF ASS�LY ❑/ Rcduc�d Pressure Principle ❑ Pressurc Vacuimm Brcakcr �' Double Chxk VaIve o Amaosphere Vacuum Broal:er Manufacturer '�`��1�,',� � Size ���- ModeiNumber l�� X �- � LocatedAi 1�rn���" �cov�� �.lP.��- �;ap_ � �l� Serial N�mmba ,��� l 3� L. �� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACLTUM BREAI�R Doubie Ch�c�%alve Assembiy lst Check 2nd Checl: Re{ief Valve Air Inlet Checic Vaive initial Tcst DGCIos� losed Ti�ht Opcned at Opened at �sid Ti�t Lcaked � t�sid �sid (�� RP-=�'sid � �'�- L,�;� ❑ � + � Did not Opcn o L,:,al:ad ❑ �P� and Materials Uscd Tcst Af3cr DC-Closcd Closc�Ti�ht ❑ Opcncd at Opmcd at osid Rcpair Ti�t ❑ �sid vsid RP sid The abowe is certified to be tcve. Firm Naaz��C.��'��r�P�� e���- Cectifie�Tcsta �'y �� Firm Address � � �.�-c ���I�-� ��Cert. Testa No.���o i.�-(�� Date � "� ` �.�' c��',m� �.^��,.r �S, 7(��'�-C� Gauge # (�3(��'�:�,�� Date last accuracy tested �-j�y Js C�iECg c�NE: IRRIGATION DOMESTIC FIRELIN� ✓ BACKF'LOW PREVENTION ASSEMBLY TEST AND CE REPORT NAME OF PWS: PWS I.D. � LOCATION OF SERVICE: � -S•I�� '`c� (�++�'� - The backflow pzevention assembly detailed below has been tested and maintained as required by TCEQ regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEIviBLY ❑/ Rcduc�d Pressure Principie ❑ Press�e Vacui�Brcakr,r e' Double Check VaIve ❑ Atmospherc Vacuum Brcaler �i Manufacturer '�n/i`����� Size �� Model Nimmber �S� �� Located At �cn��' _�ro n�- w e�� S�,�� �� �-e,I r� Serial Ntmmba d��� �D`� REDUCED PRESSZJRE PRINCIPLE ASSEMBLY PRESSURE VACITUM BREAI�R Doubie Ches�c�%alve Assembly lst Checl: Znd ChetI: �,�{y�,e 4ir Inlet Chetk Valve Ininal Test DC-Closcd Closcd Ti;ht Opcue�at Opened at �sid Ti�t � Lcal:ed o asid osid ���� RP- -r-' `' .Psid —� Lcaked o -� " `�' I}id not Opca ❑ Lcal:cd ❑ �� and Maurials Uscd Tcst Af3cr DC-Closed Closcd Tight ❑ Opcacd at Opcaed ae osid Rapair Ti�t ❑ �sid vsid RP sid Tbe above is ccrtified to be�ue. Firm Naffie��ft���7�N �t�G C�- Cctified Testa P��' '�5 � ���yS���"����t���i� Cat Teste Na � � l��' � I3ate_1� 'l f��t) Firm Address�� �� 7(va�l� c��ge # D�Q�c���. I3ate last accuracy tested ��,�.�� J S