Loading...
2016_0615 C�IECK ONE: IRRIGATION DOMESTIC FIRELINE x BACKF'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAMEOFPWS: L��?� L'' F^ L'c�(���-1� PWS I.D. � LOCATION OF SERVICE: �aII 'J�� �uG I The backllu��� prevention assembly d�tailed belo��� has been tc�trd and maintained as required by TCEQ rc�rulations and is certiticd to be operating«�ithin acceptable p�irameters. TYPE OF ASSEMBLY ❑ Reduced Pressure Princrole � Pressure ti acu�Breaker y'�'' Double Chxk Valvc C Atmosphcrc Vacuum Breaker /,.. 3���r Maaufacturcr ��Q'�TJ Sizc Modei Nimmber ��/�/ Lotated At S I� �1a u:1-�-- s��r+�b� ��� REDUCED PRESSURE PRINCIPLE:�SSEMBLY PRESSURE VACUiTM BREAI�R �S� Double Ch�csc Valve Assembly lst Checl: Znd Checl: Reiief Valve :1ir Inlet Checic Valve Inival Tat DGClosed ��� Closed Ti;ht �! Opeaed at Opeaed at osid Ti�it ,� Lea�:ed 2_p❑ vsid osid RP-_psid Leal;cd c Did not Open � Leal:e� o �� aad Mataials Usod Test After DGClosed Closed Tight o Optacd at Opcacd at esid Repair Ti�aht o �sid osid RP sid The above is cecti6ed to be true. Fum Namo f-f�-�'I O VI t"I Y2 �(1b5 Catified Tuta l JQS 0�1 STD N F�Aaa� ��.�3ok 797 Cert. Testc No.�OD I�� Date � 5 � I.UQuaG�ac�� �c ca�ge # C�/lG�7� llate last accuracy tested White- Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IIiC}C UNi:: 11�RIGA`i'ION__ llOh�ESTIC FIRELINE '\ BACKF'LOW PREVENTIUN ASSEMBLY T'EST AND MAINTENANCE REPOR? NAME OFPWS: �-��T`l C' F� Cc�(��r�/ PWS I.D. � L�CATION OF SERVICE: �I� S. � UC� Thc l�acktlo��� pre�'ct�tion assembl�� detailed bclo��� has been tc�:t�cl tind maintained as required by TCE(1 r�,r�tlaiic�n� and is ccr•titi�d to 1�e o��eratin�ti�'ithii� arre��t��l�le E�,�rair�eter�. TYPE OF ASSEMBLY � Reduc�Pressurc Princirole _ Pressure Vacu�Breaker '� Doubie Chxk V alvc C Atmosphcr Vacuum Breaka /! ��, Manufacturc: �a'�S� Sizc � Model tiumber / �`I'�� Lotated At CS�iI� (��GG��— s�;�:��,bn /Oo/7� REDUCED PRESSURE PRINCIPLE:�SSE.IZBLY' � PRESSURE YACiTUM BREAI�R ��� Doublc Ch�tic Valvt Assembly lst Checl: .nd Checl: Relief Valve Air Ialet Chock Vaive Iniaal Tcst DC-Closcd 2-� Close�Ti�ht j�1 Opened at Opened at nsid Ti�t ;,E� Lca�:cd �,['❑ nsid osid R.P-_�sid � Lcai;ed c Did not Ooen 0 Leal:ed ❑ RePan� + 3nd Matcrials Uscd Test ARu DC-Closed Closed Tight O O�enc�at Opcned at osid Rcpair Tight ❑ osid osid ttP s�a Tho above is cemfied co ix t�ve. Fum Name ff�-t'I D h t�I Y� ��b5 _ Cesti.fiad Testa l J(,�S O�1 S-1"D fv Firm Addross ;Qou ���7 Cert.Tester No. 1��1� � Date � 5 �UG{�a ha c1��2 —r Sc . Gauge # _�(o�1Q�7`rj llate last accuracy tested `�/� _.�t White- Customer's Copy Yellow - City Copy Pink-Tester's Copy c:�t�c+� urr�:: IHRIGA`PION llOMESTIC�_ FIRELINE BACKF'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPOR? NAME JF PWS: �-r'7'� (' r Lc'�(���_�/ PWS I.D. # LOCATION OF SERVICE: �ol� S. ��Q I "1�h� hackllu�r ��re��ct�tion assembl� detailed bclo�� i�as been t�;t�ct and inaintained as required by TCEC� r��rula�ie�nc and is certiti�d tc� be o�eratin����ithin acceptable p:.irameters. TYPE OF ASSE:vlBLY c Rcduccd Pressurc Princinle � Pressure Vac�nun Breaker ,� Double Chxk Valti�c � Atmosphere Vacuum Breal:tr Manufacnuc: ��Q-t'�5 Sizc 2k' Model'_vumbcr ��M 1 Located At �2.�-� �C'.) �oX Scnal N�nbcr ��D f0 � REDL'CED PRESSURE PRINC�LE:�SSE:�iBLY I PRESSURE V?�CUiJM BREAKER Double Cherk Valve Assembly lst Checl: Zad Checl: Relief�%alve Air ldet Check valve � Initial Test DGClosed 2.iJ Closed Ti;ht 1►� Opencd at Opened at vsid Ti�ht � Lea�:ed Z_?� _�sid vsid RP-�_psid � I.cai;ed C Did not Open 0 Leal:ed J RaaairC �a uau�� Uscd Tcst ABer DGCloscd Closed Tieht o ppcaed at Opcuod at nsid Repair Tigt►t ❑ nsid osid R.P sid The above is certi6ed to be true. Fum Name ��'�'I DVI 1�I Y2 1'�h5 Certifial Testa l�l,�S D►rl STO N F�Aaa,� ���ou 7g� Cert. Tastc No. G�1�� Date � 5 � �UQ xa hCt c�� -r Sc CUauge # (p/1[,b7� llate last accuracy tested White - Customer's Copy Yellow - City Copy Pink-Tester's Copy C�I�:CK UNL: I1tRIGA'i'ION� llOMESTIC FIRELINE x BACKFZOW PREVENTI�N ASSEMHLY TEST AND MAINTENANCE REPORT N�ME OF PWS: !��7� C' (` Lc-•���t/ PWS I.D. # LOCATION OF SERVICE: ��� s. K�U4 I Th� ha�kl7o��� ��r���crtion asti�inbl�� dztailed belo��� ha� been t���tccl and maintained as required by TCEQ rc��ulatic�n� aild is e�i•tihed to b� o�eratin����ithirl <�cecl�tablc ��tramet'ers. TYPE OF ASSE?v�LY G Rcducrd Pressure Princinle .. Pressure Vacuum Breaker ,� Doublc Chxk Valve � Atmospherc Vacuum Breala Manufaccure: �A�l,��-K' Size 3I��r Model'vumbcr O/�7M� LocatedAt �(r.� �'�t.lrl.��-- Scrial N�bcr f�"�lo21 REDUCED PRESSURE PRINCIPLE:�.SSE1�fBLY � PRESSURE VACULTM BREAI�R ��� Dauble Chetk 4 alve Assembly lst Check Zad Chec.k Relief Valve :�ir Inlet Checic Vaive Inival Tcst DGClosc� ��p Closed Ti�ht ,Qd Opene�at Opcncd at vsid Ti�st � Lcal:cd 2,ej ❑ vsid osid RP-_._j]sid Lcai;cd C Did not Opm 0 Leal:ed ❑ �P� and Mataials Used Tcst ARu DGCloscd Closcd Tight o pp�acd at Opcncd at nsid Repair Tight ❑ _asid asid RP sid The above is cati5ed to be true. Firm Name f�t�'t`I DYI t"I Y2 1'�.b5 Ccrcified Testa J D�l ��USYDN Ficm Address 1d��oX �C/�7 Cert.Testa No.��I LYtf� Dau � 5 � waua c�a c��e -� c�auge # �rl(�p7�j i�ate last accuracy tested White- Customer's Copy Yellow - City Copy Pink-Tester's Copy CfI�:CK UNfi: 1f�RIGA`I"[ONi_^ llOMESTIC FIRELINE BACKFLOW PREVENTION ASSEMBLY TEST AND MAINI'ENANCE REPORT NAMEOFPWS: '��7`l C� r Lc�I�l���r/ PWS I.D. # LOCATIOtv OF SERVICE: c�Il S �UQ� Thc b���kilo��' 2�re�'ention ass�mbl}' detailed bclo�� has been t��tccl �nd mai�rtained as required by TCE(1 r.`ula�ic�n< <jncl is ccrtifi�d to he o�eratin�«�ithin acce��tab]c p<<rameters. TYPE OF ASSE?vIBLY c R�duced Pressisc Princrole .- Pressure Vacu�Br�aker �Z` Douole Chcck Valvc � Atmosphere Vacuum Breal.a Manufact�� �-Q.�L.D Sizc 211 Model tiumber ��Jb Located At ��1PC�t ���c�� Sc:ial N�bcr � �� �I� REDL'CED PRESSURE PRINCIPLE:�.SSE:�IBLY I PRESSURE YACULIM BREAI�R �(�� Double Ch�ck Valve Assembly 7 lst C3ecl: 2nd Chee.{: Relief ti alve �ir Ialet C7teck Va1ve Inicial Tcst DGClosed �•� Closed Ti�ht �l Opened at Opcned at �sid Ti�it 4Z' Leal:ed �_�[ ❑ vsid osid RP-_psid � i Leai;cd e Did not Open ❑ Leal:ed J R�airs and �faccrials Uscd Test ARtr DGClosed Closcd Tight o ppene�at Opeaed at nsid Repair Tight ❑ vsid nsid RP sid The ahove is car�fied to be tnu. FumNamc ff�'�I D17 t�IY2 ��b5 CertifiedTestu IJ�SD�1 ,�—�US-rON Firm Address�(��0�( '}7 Cert. TaSta No.�UUD 1�cf � Date � 5 � (,Ua�ra�ia cL��2 �k (Uauge # C[��l(.b7� llais last accuracy tested `1/� _J*����— White- Customer's Copy Yellow - City Copy Pink-Tester's Copy CFIHCK UNL: itt.RIGATION llO1�iESTIC FIRELINE X BACT�LOW PREVENTI4N ASSEMBLY TEST AND MAINTENANCE REPORT NAMEQFPWS: L���`/ [�� F� Lc�l�� -��i PWS I.D. � LOCATION OF SERVICE: �o�� S � nUG I "I�h� hackll����� pre��rltic�n assembl} detail�d bclo��� ha� been t��tc�( <;nd maiiltained as required by TCEQ r��rula�ion� and is rcrtiticd to be o��zratin� ��'ithin arccptahlc paran�eters. TYPE OF ASSEMBLY �. Reduccd Pressure Princinle � Pr�ssure Vacu�n Breaker � Douole Chxk Valve � Atmospherc Vacuum Breal:a Manufacnuc: �a�-�S Sizc f�« Model'vumber �7`t' Located:�t 1_1�l�PS�- lA.�-�— s�►���b� 102/5� REDUCED PRESSURE PRINCIPLE:�SSEI�BLY I PRESSI7RE V�CULTM BREAKER a�� Double Ch�cic Valve?►ssembly lst Check �nd Checl: Relief Valvt Air Ialet Cbecic Vaive Initial Test DGCIoscd �•'O Closed Ti�ht }� Opeaed at Opened at vsid Ti�t ig Lcal:�d 3.2 ❑ osid osid RP-_psid Leai;ad C Did not Open � Leal:et� J Repa�rc and ;�fatcrials Uscd Test After DGClose� Closod Tight ❑ Opened at Openod at nsid Repair Tight ❑ osid nsid R.P sid The above is certi6ed to be tnu. Firm Namc�'�I O VI t"I Y2 ��b5 Ccrtificd Testa l l(,�S O�l SY0�► _ _ Firm Address ,��.�Ok 7g�7 Cert.Tester Na.������ Date � 5 � �Ua�a�ia c��e i Sc , uaUge # d!ol(Gb7� llate last accuracy tested Wtute- Customer's Copy Yellow - City C�y Pink-Tester's Copy CIIFCK UNL: 1HRIGA'I'ION_ llOhiESTIC ✓� FIRELINE BAC�'LOW PREVENTION ASSEMBLY TEST AND MAII�'TENANCE REPOR? NAMEOFPWS: �-��?� C' � Lc,i����/ PWS I.D. # LOCATION OF SERVICE: ��� SS i�UQ I �-h� hac4:tlu��� ��re�ci�tion ass4mbl} det�iled bclo�� ha� heen t��,�cl �.nd maititained as requimd by`I,C:EQ r���rul,.l�i�,n; and is �ertifi�d tc� be o�eratin� ���ithin accel�tablc p•��rametr;rs. TYPE OF ASSE:viBLY � Rcduced Pressure Princinle � Pressure Vacuimm Breaker ;'� Double Chcck Valve � A�nosphere Vacuum Brtaker Manufacr,uc: ��Gt� Sizc 21r' ;vlodel'vimmber �7/�/ Located:�t ,�m/�/�dX �_S�l��T— s�:;�:���� ,��5 7 �� REDUCED PRESSURE PRINCIPLE:�,SSE;�IBLY , PRESSURE Y:�CU[JM BRE�R � Doubl�Check Valv��+�ssembly ��� lst Checl: 2nd Checl: Reliaf Valve :�ir Inlet CLecic Valve Ini�al Tat DC-Cioscd 2-Z Closed Ti�t 1� Opened at Opcncd at vsid Ti�t � Lcal:cd 2_ p❑ �sid �sid RP-e_psid I.eai;cd C Did not Opea ❑ Leal:ed � �P� and Maurials Uscd Test A.f�er DC-Closed Closed Tight o Opened at Openod at _nsid Repaic Tight ❑ osid nsid RP sid The above is cati5ed to be tnu. FumName ff�'�'IOV11"IY� 1'�b5 CertifiodTesta I/Q.iO�I S-r0(V F�Aaa� ��J�[3ox 797 Ccrt.Tester No.�UUa 1� � Date � � � (.UQ�a hCt cL��e i�C Uauge # (p��(.�7� llate last accuracy tested white- c:ustomer's Copy Yellow - City Copy Pink-Tester's Copy C�I�:CK UN1:: I1�ftIGA'I'ION� L10D1ESTIC x FIRELINE BACKFLOW PREVENTION ASSEMBLY T'EST AND MAINTENANCE REPOR? NAMEOFPWS: �-i�?`l C' � Lc- `��t! PWS I.D. � LOCATION OF SER.VICE: �II S KpUQ� Th�� hac:kllat�� ��re��ention assemhl�� dzt�iled bclo��� has heen tc;��ct and maintained as required by 1�CEQ r��rul..i�i�,ns a�ld is ecr•tified [n be o��erating ti�-ithin acce��table ���:rameter�. � TYPE OF ASSE�vIBLY � Rcducai Pressurc Princrolc � Pressurc�%acu�Breaker �' Double Chxk V alve � Atmospher Vaeuum Br�al:tr �il ' Manufacturt: �/UQ�� Sizc Model'_vumber C�C)7M f Locatcd At /�041��dX � �S�K-eQ-'1� s��:��b� 1q7959 � REDUCED PRESSURE PRINCIPLE ASSE�LBLY I PRESSURE V:�CITIJM BREAI�R c�, Double Chcck Valve�►ssembly ✓� lst Chec1: Znd Checl: Relief Yalve Air Inlet Cttecic Va1v� Iniaal Tcst DGClosed 2.2 Closed Ti�ht J� Opeue�at Opmed at nsid Ti�t � Leal:ed 2�2❑ vsid vsid RP-�psid Lcai;ed c Did not Open ❑ Leal:ai ❑ � _ � a+r� and Mauriais Uscd Test A.fru DGCloscd Closed Tight O Qpcacd at Opcned at _nsid Repait Tight ❑ nsid osid RP sid The above is ccra5ed to be�ue. Firm Name f-���I O I'1 1�I Y2 f�.b5 Carified Tester l 11,�S 0�1 ��11 SYO f V Firm Addrrss ;�Ok ��/�7 Cert. Tester No. 1��1�� Date � 5 � I,UQ�ra hCt c��e i�C , Gauge # (Z11�75 llate last accuracy tested White- Customer's Copy Yellow - City Copy Pink-Tester's Copy