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2016_0331 C�IECK ONE: IftRIGATION DOMESTIC FIRELINE �C BACICF'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAMEOFPWS: ��?�� G'' � Lc"(��r_!J PWS I.D. # LOCATION OF SERVICE: I�II� ��l 1/l�l�G� The backilo��- prevention assembly detailed belo�� has been tcsted and maintained as required by TCEQ re�Lilations and is certitied to be o�erating�vithin acceptable parameters. TYPE OF ASSEMBLY ❑ Reduced Pressiuc Principle � Pressure Vacu�Breaker � Double Chcck Valve o Atmosphere Vacuum Breaker Manufacturer �f�l�ll�� Sizc �� Model N�ber LI��A Locatod At �l r�UI�U Yf' c S6C.t-�� SerialN�ba I��c��o '�� REDUCED PRESSURE PRINCIPLE ASSE:�LBLY PRESSURE VAC[T[JM BREAI�R A�S Double Checic Valve Assembly lst Chec{: 2nd Checl: Relief Valve :�ir Inlet Check Vaive Ini�al Test DC-Closcd 3•y' Closed Ti;ht � Opened at Opcned at �sid Ti�t � Lcal:ed 3.�,❑ psid osid RP-_psid �y;� o Did not Open o Leal:ai o �� aad Mataials Used Test After DC-Closed Closed Tight o Opaned at Opeaed at nsid Repair Tight 0 nsid nsid RP sid The above is cecti6ed to be true. FirmNauu A�-FiD/1 �I"IY�. YQDS CertifiodTuta �Q�n�n -�it)�To�r"� -- Firm Address,�L�o�C �97 Cert.Testc No.�\Cf I Date y� Gt��t S�GG(Q GG�(� �X Gauge # �(p///)o7� llate last accuracy tested White - Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK ONL: IH.RIG A'I'lON llOb1ESTIC FIRELINE BACT�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME �F PWS; �-� �`� C� (\ c-(�� .�� _ PWS I.D. � LOCATION OF SERVICE: ��n :�L1ll��d Thc hach llo��pre��ntion asse��lbly detailr;d bcl��l�� has been tcstcd ��nd maintained as required by TCEQ re��ula�i�iis and is certifi�d to be operati�l��ithin �icc�ptabla ��arameters. TYPE OF ASSEMBLY ❑ Rcduc�Pressure Principle ❑ Pressure Vacttt�Breakcr �` Double Chcck V alve � Atmospherc Vacuum Breaker Manufacturez �,{�I�1L.11�1 s Sizc 3�`�� Model'_vLmmber `�� x�2- Locaud At �I Y2 U�t�c� t� .Sai,��-1 s�►��b� 3 I1997o REDL'CED PRESSURE PRINCIPLE:�SSE:��LY I PRESSURE VACULTM BREA�R � n �� Dauble Ch�c1c�aIve Assembly u lst Checl: 2nd Checl: Relief Valve :�ir Inlet Check Valve � Iniaal Tcst DGClosed 2'o Closed Ti?ht ,� 4pened at Opened at nsid Ti�t ,�- Lcal:ed 2 � ❑ �sid osid RP-��sid ��,;� C Did not Opea o Leal:ed ❑ Repairs Iand Maurials Uscd Tcst ARer DC-Closcd Closed Tiaht o Openeri at Opcaed at nsid Repair Tight o osid DSld R.P Sld Tho above is certified to be�uue. Firm Namc Ae�� . Y �� Certified Testa �G1P� tiU�diO'1 Firm Address ��C 7 Cert. Testc No.�QIY>>C(r�SL Dau y„� �S�G�a�G�le �K tUauge # �(o/%/�07� llate last accuracy tested White - Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK UNE: I1tRIG ATION��_ DOMESTIC FIRELINE Br�C'KFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPOR? NAM£OFPWS: '—� �" �� r ,��°t� PWS I.D. # LOCATION OF SERVICE: I��h�l Ul�I�G► Tl�c hack flo�� pre�ention assembl}� detailed L�rlo�� h�i�been tc�t��i �ind n�aintained as required by TCEQ r�gulation; an��l is certificd t�� be operatin� ��'ithin �icce��table parameters. TYPE OF ASSEMBLY ❑ Rrducrd Pressure Princirole � Pressure Vactnmm Breaker � Double Chxk Valve c Amiospherc Vacuum Breaktr r Z f/ Manufacture: /.QG�O Sizc Mode:�iimmber t7J�'� Located At -FL�S`�"�al.�//'1 Serial Ntmmber ly' �2-7��a REDL'CED PRESSURE PRINCIPLE:�.SSEi�iBLY I PRESSURE VACUCTM BREAKER � �� Double Chetk Valve?�ssembly lst C3ecl: 2nd Checi: Relief v alve :�ir Inlet C3ecic Valve Inival Test DC-Closcd 2�Z Closed Ti�ht }$f Opcaed at Opened at nsid Ti�t � Lcal:ed ,Z � ❑ vsid �sid � RP-_psi Leai:cd a Did not Opea o Leal:ed � Rep airs and Matuials Uscd Tcst Aft�er DGCloscd Closed Tight o Opened at Opcaod at osid Rcpair Tight a osid osid RP sid The above is cati6ed to be�uue. FirmName Ae�,� �Y�. Y �� CertifiedTcster W�'(�r� i'h1�-ft5�� Firm Address,1 ��C ��I7 Cert.Testc No.�_�,�C(r�Sl Date s� u�SlCfGiQG�l2 �X i�auge # _�(p/%(jQ�S llate last accuracy tested White - Customer's Copy Yellow - City Copy Pink-Tester's Copy c�i�cx urrL: I1tRIG�TION� DOMESTIC�__ FIRELINE BAC'KFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: L_�!� �' r ..�T��/ PWS I.D. # LOCATION OF SERVICE: I�1� �l 1/1/.��_/i Thc hackilo�� pi-e�ention assembl}' detailed bel��t� has been tcs;cd ��nd iiiaintained as required by 1'CEQ r��Julations and is c�rtiti�ci to re o�eratin��ithin acce�tabl� ��irameters. TYPE OF ASSEMBLY ❑ Reduced Pressurc Principlc � Prtssure Vacuum Breaker y5� Double Chcck Valve c Amsospherc Vacuum Hreal:a Maaufacnue: �,c0�t-l� Su� 2'' Mode!'vumber ��/�� Located At �ClS-� (QG✓YI Senal N�ber ��U 22 REDUCED PRESSURE PRINCg'LE�SSE:�SBLY I PRESSURE VACUUM BREAKER � Double Ch�c.k Valve�lssemblv �� lst Checl: lad Chec1: Relief v aIve Air Inlet Check Valve Iniaal Tcst DC-Closcd f r 8 Closed Ti�ht t� Opened at Opeaed at osid Ti�t �` Leal:ed 2 2 ❑ �sid osid RP-__psid Lcai:ed e Did not Opea o L.eal:ed C� Repairs and ;vlatcrials Uscd Test ARer DGClosed Closod Tight o Opened at Opcaed at nsid Rcpair Tighc ❑ nsid osid RP sid The above is certifie�to be true. Firm Name Ae�-� �V�. ��L?� Certifiod Testa I/Gt��_�.�!� Firm Addr�ess G�C 7 Cert.Tcstc No.��'Y�\C�S� Date,-�y�.,, aucr�ca cG,l� �TX V�Uge # [��Dll(�o-7� llate last accuracy tested White - Customer's Copy Yellow - City Copy Pink-Tester's Copy CFIEC,K �UNL: iKRIGA'I'ION DOI�iESTIC FIRELINE � BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT i�1AMEQFPWS: �-l�7`� C� �' Lc.-O��/ PWS I.D. # LOCATIDN OF SERVICE: ��/� �I 1/I/�0�� Thc hackllo�i• ��re��e��tion ass�mbly detai1ed bcl�n��1�a�been tc,`ccl and maintained as required by TCE(� r��ulalion� and is certiiicd t<.� he o}�eratin� «�ithin <icce��table p��rameters. TYPE OF ASSE.�LY c Rcducrd Pressure Princi�le � Pr�ssure Vacu�mm Breaker � Double Chcck Valve c Atmosphere Vacuum Breaker Manufacrure: IAJ(.(�C/!VS Sizc 3��-{-�� Modei'_vtunbc: � l 2 L.ocated At �ll��°(ICw c.l �� S�_�a w� s��:��b� 3�� 7/� REDL'CED PRESSURE PRINC'IPLE�SSE:�iBLY PRESSL'RE V;�Ci7UM BRF.AKER � Double Cherk��aJve Assembly �� lst Checic 2nd Ched: ReIief Valve Air Inlet Check Va1ve Iniaai Tcst DGCIosed '2�� Closed Tiaht � Opeaed at Opencd at osid Ti�t ,� Lcal:ed � � ❑ psid osid RP-�psid �;� ❑ Did not Open o Leal:ed � Rep�;n and MauriaLs Uscd Test ARer DGClosed Closcd Tie,�t ❑ Opened at Opcned at nsid Rcpair Tieht � DSid osid RP sid The above is catificd to be true. Firm Name Ae�� Y� ►�� Ccrtified Testa �St�� t't11ST�1 Firm Address d x 7 Cert.Teste Na�Pc'Y��C�SI Date s;�� l uLr�t a GG►le l X Gauge # _�(011�D�� 1)ate last accuracy tested White - CustomerTs Copy Yellow - City Copy Pink-Tester's Copy CFIECK UNE: IKRIG AT10N_� llOMESTIC FIRELINE BA.CKF'LOV4'PREVE:VTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME QF PWS: ',� �`/ C� � c-�� .!/ PWS I.D.� LOCATION OF SERVICE: /'�17 �I 1/I�P�Gi Tl�c l�ack ilo�v pi-e�entic�n asse�nbl}� detail�cl bclo�� has bee�l tc�tcd and mai�ltained as required by TCEQ re��ulations and is certified t�� he opet-ating��'ithin acc�pl�lhle p�iiameters. TYPE OF ASSEMBLY ❑ Reduc�d Pressure Princrole � Pressure Vacu�Breaker � Double Chxk V alve C Atmosphcrc Vacuum Breaker Manufacnue: �-� ' � Sizc 2�� Model'v�ber �� Located:�: ��a.f-�t I�(,v�'1 s�:;��b�: ��Do3 REDtiCED PRESSURE PRINCIPLE�SSE:�SBLY I FRESSURE VAC[JUM BRF.aKER ' �� Double Chetic��alve Assembly lst Checl: Zad Chec{: Relief Valv� �►ir Inlet Checic Valve Iniaal Tcst DC-Ctosed�.L� Closed Tight �f Opcned at Opened at vsid Ti�t 1`� Lcal:ed 2 � ❑ psid �sid RP-�psid �;� � Did noc Open o L.eai:ed o Rtpairs and Maunals Uscd Tcst After DGCloscd Closed Ti�t ❑ Openad at Opcaed at nsid Repair Tight ❑ �sid osid RP sid The above is ccrtified to be true. Firm Namc �te�"t 0�l �i"�Y E YlZD S Certified Testa � - Firm Address GK J 7 Cert.Tester Na. l��Y��Q(��l Date,i� C1 S�Cr�Q cG,le X Gauge # _Q(p//�jQ�� llate lxst accuracy tested White - Customer's Copy Yellow - City Copy Pink-Tester's Copy c�i�;cx orrL: IHRIGATION DOMESTIC _ FIRELINE� BAC'I�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OFPWS: �-,_��7T C� � �c-n�r.�� PWS I.D. � LOCATION OF SERVICE: I 2� �I Ul�l�G1� Th� backflo��' pre�'ention ass�mhly detailed belo�� h�+s been tcstcd and maintained as required by TCEQ rc�sulations and is certified to t�e operatitig��ithin acceptable p�irameters. TYPE OF ASSEMBLY ❑ Reduced Pressurc Princi�le � Pressure Vacuum Breakcr � Double Chxk V alve e Atmosphere Vacuum Hreaka Manufacture: �.t/l l,�/�'.S s�� f3 '' Model'_vumber t��O,�A Located At �11�'-2 V4 u ��- EQS`T �L�ca�v1 s�;��;�b� N yW a�o REDL'CED PRESSURE PRINCIPLE:�.SSE:�iBLY I PRESSURE VACUCTM BREr�I�R � �l� Double Ch�ck�alve?�ssembiv lst C3ec1: 2nd Checl: Retief Valve :�ir Ialet Check Valve Iniaal Tcst DGCloscd Closx'Tiaht ❑ Opcned at Opened at nsid Ti�t c Leal:ed ❑ nsid nsid R.P-^psid L,eal:cd a Did noc Open ❑ LeaI:ed ❑ Repairs and MaccriaLs Uscd Test After DGClosed Closed Tight o Opeaed at Opeaed at osid Repair Tight ❑ �sid osid RP sid The above is ccti��to be true. Fum Name Ae�-�on �v e� Yi2�� Cerdficd Testa �� i't �� Firm Address dx 7 Cert.Tester Na 1�plY�\C(oSl Date,i;�� a S�'rGcQ cl�l� "Tx Gauge # �(�//�07� llate last accuracy tested White - Customer's Copy Yellow - City Copy Pink-Tester's Copy