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2016_0316 C�IECK t�NE: IR.RIGATION DOMESTIC � FIRELINE BACKF'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPOR? NAIv�OFPWS: L��?`l G� r Lr�(��J PWS I.D. # LOCATION OF SERVICE: c�f 7 W C c v,�t e� I�r Thc backfilow prevention assei��bly detailed below has been t�stcd and inaintciined as required by TCEQ regulations and is certi�ed lo be o�erating witl�in acceptable parameters. TYPE OF ASSEMBLY ❑ Reducad Pressure Principle O Pressure Vacu�Breaker � Double Check Valve ❑ Annosghere Vacuum BreaL-er Manufact�cr �� T�5 Siu � Model Number n�7 wl I Locatcd At AJ� S�,c. v v� SYi-C ' Scria!Ntmmber �8 i 6 3 REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V�CCTUM BREAKER Doubie Check Valve Assembly lst Checl: Znd Chec{: Relief Valve 4ir Inlet Check Valve Ininal Test DGCloscd Closed Ti;ht ,� Opeaed at Opened at esid Ti�t o2o r5P Leal:ed ❑ nsid nsid PG ry' �-_-Psid o�� j,C3�G� � Dld IIOt�3CII O j,C3�Cd ❑ Repairs and Materials Used Test Aft�er DGClosed Closod Tight o Opeued at Opcaed at _nsid Repair Tight ❑ _osid osid RP sid The above is certi6ai to be true. y�> Firm Name �4c%�G e•. F'�� Certified Tescet � I�J c, r.�c 1��v,,�p- Firm Address �c� �Jc '�9`7 Cat Te,ster Na �o0 9�l�5 D� 3/'9/�� c�;C� 7 w �75�G 5 tUauge # C�3 Oua��J� `�' llate last accuracy tested 3f/L White - Customer's Copy Yellow - City Copy Pink-Tester's Copy C,�IEC� �NE: IRRIGATION DOMESTIC � FIRELINE BACI�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: �� G� � LcT A��I PWS I.D. # LOCATION OF SERVICE: r�`�i, (��'c�c,i e� D / The backtlo�� prevention assembly detailed belo�� has been testcd and maintained as required by TCEQ re�ulaiions and is certifi�d to be operating within acceptablc parameters. TYPE OF ASSEMBLY ,BC7 Reduced Pressure Principle o Pressure Vacu�Breaker ❑ Double Chcck Valve ❑ Atmosphae Vacuum Breal:er �/Z Maaufacrurcr W c-�� 5 Size Model N�ber o0 9 � r Locaud At Ot d (3 ra� (L�,,� C I t L ,�.,`r_-� Scrial Nimiber 3 3 `< <' '�� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACLTUM BREAI�R Dout�ie Check Valve Assembly lst Checl: 2nd Checi: �tf Valve �1ir Inlet Check Valve Ininal Tcst DC-Closcd Closed Ti�ht $D Opened at Opened at nsid Ti�t � Leal:ed ❑ �-� nsid osid �ei5 RP-�sid � � � L.cai:ed ❑ Did not Opea o Leal:ed o �� and Mataials Usod Test After DGClosed Closed Tight o ppeaod at Qpcaod at nsid Repair Tight C7 nsid esid RP sid Thc above is certified to be�ve. �/� 5 Firm Name A-c�'�dv� 4'r-�- Cectified Testa �i,J�v�t 1��c�,�•P� Firm Address Q� �-�x �5 � Cert. Testa No. cxx��i�l�5 Date 3/�1/b 6t1o� T� 75/�5 Gauge # U 3 0.� �� llate last accuracy tested 3��6 White - Customer's Gopy Yellow - City Copy Pink -Tester's Copy C�IECK t�NE: IRRIGATION DOMESTIC FIRELINE )Q BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: �r�?`I _ �' F' L�r��'1!J�11 PWS I.D. # LOCATION OF SERVICE: c� �1 W tcv�G(�. (� T The backflaw prevention assembly detailed belo�� I�as been tested and maintained as required by TCEQ rc��ilatic�ns and is certitiec� to be operating �vitl�in acceptahle parameters. TYPE OF ASSEMBLY o Ruiuced Pressurc Principle o Pressure Vacu�Breaker �0 Double Chxk Valve o Amnosphere Vacuum Breaker Manufacturer ��5�-� su� 31`/ Model N�ber �Q L Locatad At S-� ►l cvc. � Scrial N�bcr (� (� � � REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V�CUIJM BREAKER Double C3eck�alve Assembly lst Check lnd Checi: Relief Vatve :�ir Inlet Check Valv� Initial Test DC-Closed Closed Ti�t $9 Opened at Ogened at nsid Ti�t `�1 Leal:ed , ❑ _nsid osid �,►�55 RP-�sid o�� Lealxd o Did not Opea o Leal:ed ❑ �P� and MateriaLs Uscd Test ARer DGClosed Closed Tight o ppeaed at Opeaod at __nsid Repair Tight ❑ �osid ��nsid R.P sid The above is certified to be true. v�r 5 Firm Name A-c��, ��--- Ceitified TeStCt 1 `1h+CY N'G 1.tJ�G►�►n e� Firm Address Qo �a�x 7S l Cert Testa No. n�G`�>>� Date �' j S/i6 li�cx j� '7�lVy Gauge # (7 3!�8�J j �l llate last accuracy tested 3/�6 White - Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK ONE: IRRIGATION DOMESTIC FIRELINE � ��,� BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NANIE OF PWS: L r�?�,� G'� � L'c-�(-��.�ll PWS I.D. # LOCATION OF SERVICE: � �� W J�� c�- n t The backflo�� reventian assembly detailed below has been tested and Inaintained as required by TCEQ regulat�ic�ns and is certified lo l�e operating within acceptable parameters. TYPE OF ASSEMBLY o Reduc�Pressure Principle o Pressure Vacu�Breaker � o Atmosphcrc Vacuum Breaker Dc p� Manufact�er !��'S�� Siu 8 Model Number � � t� Locaud At ,5- � t!c��- � Scrial N�mmber �� 5"6�ic� REDUCED PRESSURE PRINCTPLE ASSEMBLY I PRESSURE VAC[TUM BREAI�R Double Check V alve Assembly lst Checl: ?nd Checl: Reiief Valve :�ir Inlet Check Va1ve Inival Tsst DGClosed Closed Ti;ht (� Opeaed at Opened at __nsid Ti�t �,� dD Leal:cd �6 ❑ nsid osid �c s; RP-�psid Leal:ed o Did not Opea O Lealced O �� and MatGrials Usal Test ARer DGClosed Closed Tight o ppeaed at Opeaod at osid Repair Tigt�t ❑ nsid osid RP sid The above is cetrifie�to be tcue. V�S Firm Name d�no v. �'.--� Catified Testa ��W��t- W��,�,�� Firm Address �� x 7 5`7 Cat'Tester Na c�c.�c�s`�� D� 3 �5�� Ilcx i x 7s i6�' CGauge # v 3 eF;.�.�� llate last accuracy tested 3�/6 White - Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK +ONE: IRRIGATION DOMESTIC FIRELINE � �� G�j5 BACKFT.OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAMEOFPWS: L��`� �'� L'r_�(-)��1 __ PWS I.D. # LOCATION OF SERVICE: r�(1 1+J C�c�o,t-r �r The backilow prevcntion assembly detailed belo�v has been tested and maintained as required by TCEQ rcbulations 3nd is certified t�o be operating within acceptable parameters. TYPE OF ASSEMBLY ❑ Reducrd Pressure Principle ❑ Pressure Vacu�Breaker y� Double Check Valve ❑ Atmosphere Vacuu�BreaL-er Manufacturcr r��r s�..� Siu 3(`� Model'v�ber �� Locaud At .5-1cJ U�'v� i Scrial N�ber c>n �Jw� REDUCED PRESSURE PRINCIPLE ASSEMBLY I PRESSURE VACULJM BRF.AKER Doubk Chetk Valve Assembly lst Checl: 2nd Checl: Relief Vaive �lir Inl�t Check VaIve Inival Test DC-Closed Closed Ti;ht � Opeaed at Ogeaed at nsid Ti�t �9 Leal:ed (,� ❑ nsid osid �G`'S RP•�sid Lcal;ed o Did not Open O Leal:ed ❑ �P� and Materiats Used Test Af3.er DGClosed Closed Tight o Opened at Opcne�at nsid Rspair Tight C7 �sid osid RP sid The above is certified to be�ue. y�� Firm Name�1 c'�ne h �� Certifi�d Teste �kJ�+�-L W�Y,H� Firm Address pr� KG x �9 � Cat Testa No. �c�d 9�ld S Date 8 16 U/cx ? � 75/Gy Gauge # �3op�J;��8 llgte last accuracy tested 3f�G White - Customer's Capy Yellow - City Copy Pink-Tester's Copy CHECK ONE: IRRIGATION�_ DOMESTIC FIRELINE BACKF'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: L��7`I G� (� L c=�,T��I PWS I.D. # LOCATION OF SERVICE: r,�� W �C�1G L 4;� n � Thc backtla��prevention assei�ibly detailed below has been test�d and maintained as required by TCEQ regulati�ns and is certified to be operating within acceptable parameCers. TYPE OF ASSEMBLY ❑ Reducrd Pressure Principle Q Pressur�Vacu�Breaker b� Double Chxi:V alve ❑ Atmosphcre Vacuum BreaL•er Maaufacturer �� b c e� Size .� Model Nu�bcr cg U ti�, L,ocated At A�• �c d� ��n S ?�« % Serial N�ber ��c�3o�o0 REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACiTCTM BREAKER Double Check Valve Assembly lst Checl: 2nd C3ecR Relief Valve :�.ir Ialet Checic Valve Iniaal Test DC-Closed Closed Ti�t 18� Openod at Opeaed at osid :��j Ti�t �,(� � Leal:ed �, ❑ osid nsid �� RP-__psid `�v Leal:od ❑ Did not Open O Leal:ed ❑ �P� and Mataials Used Test ARes DGClosed Closod Tight o pp��at Opcaod at nsid Rtpair Tight C1 vsid nsid RP sid Thc above is certi6od to be true. ��-5 Firm Name�e`�,e� �:'� __ CCctified Tester D 1�ay�-c. W'� v►vt �� Firm Address Qc� �x 7 91 Cert.Testa No. c�c�c��`I�� Date 3 I 6 �U1cx rx �,IbS Gsuge # C� 3�t��7�j� llate last accuracy tested 3�/� White - Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK ONE: IRRIGATION DOMESTIC FIRELINE �,c�.ow P�vErrrior��ss�LY��sr�xn r��c��oKr NAME OF PWS: �r"r�/ ,d F' C�,A��U PWS I.D.# LOCATION OF SERVICE: �'�7 t�J'�„C/T� (�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 ASSEIVIDLY ❑ Rcducxd Presstac Principie O Pressure Vacu�Brcaka � t'�° c�� k�vt o ,�m�osphere V�Bresler Maaufactiaer � e� 5�_� Siu c� Model Iv�ba �� L.ocaud Ai S � 1/cc�c i Serial N�mmber o nc�_s 6 5/ REDUCED PRESSURE PRINCIPLE ASSEMBLY PRES�URE Y4CUUM BREAKER Double Check ti alve Asa�bly lst Check 2nd(�eck Rdief Ya�ve Air�niet C6eck Valve Inidal Test DC-Closed Closed Tight ,Q� Opened at Opencd at nsid Ti�t� � � Leal�d Q?g ❑ vsid osid � �/155 Rp_��sid � L.eal.� o Did not C)pea o L.eaked ❑ �P� � Mataials Used Tast ABer DC-Closed Closod Ti�ht ❑ Opmed at Opened at �psid Repair Tight o ,�id nsid RP "d The above is cartified to be tn�e. '`��S Firm Name �c�v�q C�'�� Catified Tester Q wc:x,.� �.✓�e h K� Firm Address po ��o �5 � Cat TaterNa �d�9�I�S �e 3�9//� W4� � 7s�G5 Gauge # _!�3��j�� Date last accuracy tested 3��, White- Customer's Copy YeIlow -City Copy Pink-Tester�s Copy