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2016_0224 (2)
iC�IECiK �C1NE• IRRIGATI�N DOMESTIC l ' FIRELiNE BACKFI.OW PREVE�pN AS5EM8LY TEST ANp MAINTENANCE REPORT I�IAME(]F PWS: ��'?�/ G'�F' (`e���,�r� PWS I.D.� �ac�rrc��o�s�vzc�: I Z� l �' � S� �-r�ti �Q ��.� The back�law prev�ntion assembly detaiieci below has been te�t�d and maintained as required by TCEQ regul�tions anci �s�ertific�l io be operating r�rithin acceptable parameters. TYPE C3F ASSE3vIBLY o Rcduced Pressare Priacip�e o Pressurc Vacuwn Breaker (� 13ou�lc Ch�c Vahrc c A�aospherc Vacuum Breal�er Maaufacturer �i✓�� Size x � � ModeI Iv�nber � � � � � Locat�x3Ar 1/�a.v I fi � � Sr� S�i/e��ek�-�� Serial I�irnnber l�� � 7 / REDUCED PRESSURE PRiNCIPLE ASSEMBLY PRESSURE VACIIUM BRE.4KER Daubte C7zecic�%alve Asscmbiy 1st Check 2nd C6ec1: Relief'Valvt Air Inlet �heck VaJve Zniaa!Test DC-Closcd Closed Ti�t � (3peue�at Opened at �id Ti�t 3 � v � � n _____--�asic3 r�ns,c3 Q�n �-�p��a 3 c.,' L.�al:ed CI ' Did nat Opea D Lealccd ❑ RaP�irs aad Materials Used T"est After I�C-�Closed Close�Tig,�t O ��� (�pm�at nsid Rzpair Tighc ❑ _���sid ____,,.,____esid —T �' ia "Fhe above is c:�tified to be true, �i�m l�a�ne C��1 �` ���r�e� �✓v� � � Cert�ed Tssttr __ � �tiLv�, �- ����4� S ����- P a ►�o x �q � ��,�.�,��.Y�Na, � ��� 3�r D� z -Z�-�� � �auge # D3 2 Z � ��6 �ate iast aC�u��y testea �'— / .S White - C�stocner's Copy Yellow - CitY CoQY Fink- T�er's C�py