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2016_1115 c�l�cx urrL: 1ftRIGATION X DObiESTIC FIRELINE BACKFLOW PREVENTION ASSEMBLY TEST AND MAi1VTENANCE REPORT uA.�o�Pws: ���T� c� r c��-����--« PWS I.D. h LOCATION OF SERVICE: �'J-J ��rT P ��.1.1`� The bachflo��� pre��entioi� assen�bly detailed belc���� has been te��ecl and maintauied as required by TCEQ re��ulati��ns and is certi�iicd to be o}�eratin�� ���itl�in acceptabl� para�l�eters. TYPE OF ASSEMBLY ❑ Reduced Pressure PrinciDle � Pressure Vacuimm Breaker � Double Chxk Valve � Atmosphere Vacuum Breaker Manufacture: �L�O Size 2�c Model'vumber Ub'J� Locatcd At � ViJ��-c� �► S-�f'-Ps�--�— s�:►��v�b� U'ZZ�Co REDL`CED PRESSURE PRINCIPLE:�.SSE:�LBLY ( PRESSURE V�CULTM BREAI�R Double Cherk�alve?►ssembly lst Checl: Zad C3ed: Relief Valve Air Inlet Chtck Va1ve Inival Tcst DGCloscd ,.S Closed Ti�ht � Opcaed at Opened at nsid Ti�t � Leal:cd 2,p� psid vsid RP-_psid Lcai;cd ❑ Did noc Open ❑ Lral:ai ❑ i �P� and MatcriaLs Uscd Test ARer DGClosed Closed Tight ❑ Opeaed at Opcaed at nsid Rcpair Tight ❑ osid osid R.P sid The above is catifiod to be true. Firm Name�� �ID� t- I Ir� P�s Certified Testa ,,,(11� S TO� Firm Address �1'��'�7 Ccrt. Testc No. �� �� Date � � � (��xc�1nc�c-h� �x Ciauge # 0�0110� l7 llate last accuracy tested 2 (p raL._a., r."^a_—__�� ��.... v..77..... .. I�:a., l�...... D:..b_Teotnnl� !`nnv CFIEGK UNE: 1KRIG ATION DO h'IESTIC FIRELINE�_ BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT N�1ME0�"PWS: ����`/ L'� F� Lc•(���[� PWS I.D. # LOCATION OF SERVICE: �� ��r—� Pl�c,�� "I'hc hackllas�� pi�e��entio�� assembly det�ailed bcic»�� has heen tc�tc�l and maintained as required by TCEC� rc�rulations aild is ccrtiticd to he qpei•atin�����ithin acceptablc parameters. TYPE OF ASSEMBLY ❑ Rcduced Pressurc Princiole � Pressure Vacuimz Breaker y"� Double Chxk Valve � A�ospherc Vacuum BreaL•er 8 �r Manufac:aue: Size Model'vumber flC��. Located At s� �\r�U��GiI� (T s�;���b� �qC�b3� REDL'CED PRESSURE PRINCIPLE:�SSE:��LY I PRESSURE V�C[T[TM BREe�R Double Cherk Valve�►ssembly lst C3eck 2ad Checl: Relief Valve :�ir Inlet Check Va1vt � Ini�al Test DC-Closcd 3��- Closed Tight k� Opened at Opened at nsid Ti�t b� Lcal:cd �,(� ❑ psid osid RP-_psid Lcai:ed o Did noc Opea ❑ Leal:ai ❑ Repairs . and MataiaLs Used Test A.f?er DGClosed Clased Tight ❑ Opeaed at Opcaa!at nsid Repair Tight ❑ �sid osid RP sid The abovc is ccrti.fied to be true. Fism Name�C_-�!D t� f- (1�� P�S Ccrtified Testa ,,,(�Q�� S TO� Firm AddrGss �����7 Ccrt. Tester No. ����Date � 5 � (,��xa ti���h�2 `�x uauge # 0(0�(OC��� llate lAst accuracy tested 2 (p i�71.Ca,. r^�....a.,�...._t.. !"���.. V..77..... __ l�:�., /'�...... Di.�b_Tooto�.lc� (`nr��v C�IEC�i t1Ni:: IRRIGATION DObiESTIC FIRELINE � BACKF'LOW PREYENTION ASSEMBLY TEST AND MAINTENANCE REPORT' N�ME OF PWS: �� 7,� L'' (l L c.•f���-[/ PWS I.D. � LOCATION OF SERVICE: �,� �I�-QfL GY�YT /"/�LU'� Tl�c b<�ckflo�r� prevention assembly detailed belc����has been tc�tcu and mai�itained as required by TCEQ rc��ulations and is ccrtitied tc� be opet-atin� ��'ithin a�ceptable parameters. TYPE OF ASSEMBLY c Reducrd Pressurc Principle � Pressure Vacuimm Breaker f� Double Chxk Valve � Amiosphere Vacuum Breal:er 3/4 ic Manufac�ure: � Size Model'vumber ��G LocatcdAt 5�.i F1Y'�.1�A►-1�'� Seria!Ntmiber -1 I �23b REDL`CED PRESSURE PRINCIPLE ASSE:�LBLY I PRESSURE V�CULTM BREr�R Double Check Valve�►ssemblv lst Chec�: 2nd C3ecl: Relief Valve :�ir Inlet Checic Valve Iniaal Tcst DGCloscd �. � Closed Ti�b.t � Opened at Opened at �sid Ti�t � Leaked 2 Z�❑ psid osid RP-_psid Lcai:ed ❑ Did not Opm O L.eal;ed ❑ Repairs . and Matcrials Used Test After DGClos�d Closed Ti�ht o Opened at Opeaad at nsid Repair Tight ❑ nsid nsid R.P sid The above is certificd to be true. Firm Name �C_� 10 V7 1- I I��Z P OS CeStified Testa (���t-r" 5 TQ�•I Firm Address �f'��7�7 Ccrt.Tesur No. OI S/ Date � � �o (�G�xG2 y1ct�-h� Tx Gauge # �(ol�OC��� llate last accuraey tested 2 (o i���.ta,. �.__a..,..._t.. �'v..�._ V..77,.." _. /�:�.. !'�...... D:.,b_�i`no+e..�c l�iv.v c�i�c� uNL: I1�RIGATION DOMESTIC X FIRELINE BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NA.�vLE OF PWS: �-i�'/ C' (� C_T p�-!! PWS I.D. # LOCATION OF SERVICE: �,'J-� �I�.�Q�Y� Pl�w�� Tl�c hackl7c���� ��i-e��ention assembly detailed belo��� h��s been tc�t�cl ai�d �naintaiiled as required by TCEQ rc��ulation; and is ccrtiticd to be operatin�� within acceptablc parameters. TYPE OF ASSEMBLY ❑ Reduced Pressure Princirole � Pressurc Vacuiun Breaker p�� Double Check Valve � Atmosphere Vacuum Breal:er Manufac:�e: (.l�Q tts Size /L�� Model'vumbcr ���2 Located At S� �" Y�Q--�-CI(^ s�►���b� C�8335 REDL'CED PRESSURE PRINCIPLE:�.SSEtiSBLY ( PRESSURE VACU'LTM BREAI�R Double C��ck�alve Assembly lst C3ec1: Znd Checl: �e{V alve Air Inlet Check Vaive � Initial Test DGCloscd 2,Q Closed Tight � Opcncd at Opcned at nsid Ti�t 2�. Lcal:cd 2.C'� psid osid RP-_psid Lcai:ed ❑ Did not Opca ❑ Leai:ed ❑ Repairs . and MataiaLs Uscd Test Aft.er DGCloscd Closed Tight a ppeaed at Opcaed at osid Repair Tight � DStd osid RP Sid The above is cati5ed to be true. Firm Name �C_�ID� �I Y'� C(�oS Ccrtified Tester 1 ,�D S TQ� Firm Address �f'C�7�7 C«t Testc No. 0� S� Date � 5 � (�J c�uc�1na c.�� �x C�auge # ��o���C�`7� llate lAst accuracy tested 2 (o Tua.:a.. r�...,a..�.__�.. r+_.... V..77..... ... I�:+.. l�....<. Diwb_Tee4�a�.tc� �'nnv CFI}�CiC ()NL:: IRRIGATICIN DOMESTIC X FIRELINE BACI�ZOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: �� �`l L'' (� Lc-f���-1/ PWS I.D. # LOCATIO?�+OF SERVICE: �� �Y'.P�G�I�� P/�Cl�� Thc back Ila��� ��r�vention ��stiembly detailed b�lo��� has been tcstcd and maintained as required by TCEQ r��rula�ions and is ccrtilicd to be operating�vithin acceptable p�rameters. TYPE OF ASSEMBLY ❑ Reduced Pressure Princrole � Pressure Vacuum Breaker y�'. Double Chcck Valve L Atmosphere Vacuum Brea�:er /' ' i� Manufac:iuer WQ Size � Mode:'_tiumbcr ����� L,ocatedAt �J� � 1�-�r s�;�r��b� u.h r�cl�b 1Q REDL'CED PRESSURE PRINCIPLE:�SSEI�LBLY I PRESSURE VACUITM BREAI�R Double Check�alve Assemblv lst Chec1: 2nd Checl: Relief Valve :+►ir Inlet Check Va1ve Iniaal Test DC-Closed �•g Closed Ti�t � Opened at Opened at nsid Ti�t � Leal:cd �• (p ❑ nsid osid RP-_psid Leai:ed ❑ Did not Open O Leat:ed G Rtpain . !and Maurials Used Test After DGClosed Closed Tight o Opeaed at Opeaed at nsid Rtpair Tight ❑ nsid osid R.P sid The above is catified to be tr�u. Firm Name /�<�!D� } I Ir� P2�S Certified Testa (��1 S TQ� Firm Address �f'n�'�7 Cert. Tester No. OI GY S/ Date � 5 � w�xa�na c-�-��2. `i—x Gauge # �(ol(OC��j� llate last accuracy tested 2 (�, S.i�.:a.. r.....a.,�__r., n._..... V..tt..... _. l�:t., l�...... D;..4_T�tn��c !''nna� C�IECK ()NE: 1RRI�ATIOI3 llOMESTIC FIRELINE BACI{FZ.OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAIviE OF PWS: �-.� �;� C' (-� Lc-�`T�ii P�'S I.D. � LOCATION OF SERVICE: q'JJ �I�.QIL�Y� PI�LU`� The backll�z��� pre��ention assembl�� detailed beloE�� has been tcsteci ancl maintained as required by TCEQ re;rula�ion� and is certii�ied to be operatin�=��'ithin acce��tat�l� p��rameters. TYPE OF ASSEMBLY ❑ Reducrd Pressurc Princrole � Pr�ssure Vacuum Breaker �` Double Chxk Valve � Atmospherc Vacuum Breal:er ���„ Manufacrure: Size Mode:'v�ber � L,ocat�d At 1V�l) t-1Y�.2�CI.UI l� s��N,�b� qq 722� REDUCED PRESSURE PRINCIPLE:�SSE?bIBLY I PRESSURE V�CULTM BREAI�R Double C3etk Va]ve Assemblv ist Checl: Znd Checl: Relief Valve :�1ir Inlet Check Valve I Inival Tcst DGClosed Closed Ti;ht Jd�i Opened at Opened at nsid Ti�t �. � � Leal:ed �, (o ❑ psid nsid RP-_psid Lcai:cd o Did noc Opcn o Leal;od o �� . �a uau�� us�a Test Afttr DGCloscd Closcd Tie�ht ❑ Opcned at Opcacd at �sid Rtpair Tight o nsid nsid RP sid Thc above is cetified to be true. Firm Name �C_�!D I� �I 1�� PQ�S Ccrtified Testa (��SD� S TO� Firm Addr�s �!'����7 Cert. Taster No. 0� S/ Date � 5 �o ��xcc 1n�C--1-�r2 `I—x Gauge # �(ol�OC��� llate last accuracy tested � (o n��.cs.,. �..._a.,�,.��.. n..�.. V..77..," _. l�:�., /�....., Di..L_Teo+sntc (''nna� C�IECK UNE: IRRIGATION DOMESTIC FIRELINE f� BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAMEOFPWS: ���?`l G'' (-� Lc,(�L��� PWS I.D. # LOCATION OF SERVICE: q� �I�.PQ�YT P/L Ll�'� Thc hackflo��� prevention assembly detailed belo��� has been tcsted and maintained as required by TCEQ re�ulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY ❑ Reduc�d Press�e Principic ❑ Pressure Vacu�Breaker � Double Chcck VaIve ❑ Amoosphcre Vacuum Brealer Qn Manufacturer S Sizc U Model�vi�ber �� Locatcd At N� �11f'����'t� s�;�x�b� �q 0(0�33 REDUCED PRESSURE PRINCIPLE:�SSE:VLBLY PRESSURE VACLTUM BREAKER Double Check Valve Assembly lst Checi: 2nd Chec1: Relief Vaive :�ir Inlet C3eck Valve Inival Test DGCloscd Closed Ti�ht t�' Opened at Opmed at �id Ti�t �. (o "6( Leal:ed Z,g ❑ psid osid RP-_psid Lcai:ed o Did not Opea O Leaked ❑ �� and Maurials Used Test After DGClosed Closed Tight ❑ Opcaed at Opeaod at esid Repair Tiaht o nsid osid RP sid The above is cerdfied to be tnu. Firm Name�C_�!D i� } 1 I/� P OS Certified Testa ��QSDh S TD� Firm AddrGss ��7�7 Ccrt.Tester No. OI S/ Date � � � w c�xa lnc�c-h� `rx Gauge # �lol�OC77� llate last accuracy tested 2 (�; White - Customer's Copy Yellow - City Copy Pink-Tester's Copy