2017_0111 c���c� ux�:
IiiE�IGATION��� DOMESTIC � � FIR�LiNE�_
BACKFL�W PREVEI'+1'TIQN ASSEMBLY TEST AND MAiNTENANCE REPURT
NAM.�QFPW�: Lf?` ���q��/
PWS I.D.#
�.t7CATTON�P SERVICE: Walgreens#04418 313 N. Denton Tap Rd.
The backt7�j����prevention a�sen�bly de2ailed belotiv has be�i7 tested a�nd inaintained as required by TCEQ
re�ulatit��ns and is ce�-titied to l�e o�eratin�withiti acceptal�le par�i�T�e�ters.
� TYPE OF LY
Reducrd Pressurc Principle Pressure Vacu�Brc�kcr
� Doubie C�cek Valve Atmosphcre Vacuum Brea�er
,������� Wilkins $� 1-1/2"
Model Numbez 950XL Located Az @ meter on SE corner of property
S������, 550377
REDUCED P�SSURE PRINCIPLE�iSSE.'�LY � PRESSURE YACLTUM BREAKER
I?oui�ie Chetic V a}ve Asstmbly
Ist C3ec1* '-$d Checi+ Relief Va1ve A,ir Fnlet Check Va1ve
Iuid�l Tat DC-CPo�d losc�Ti,ght Opene�at 4gened at nsid
� Ti l Leal:ai vsit� DSI�
��L� �-�� / DSI �, L Q
J L� Did noi Open D Le�cd
�'�LD�ifS
�
Materials
Uscd
Test Afi�r DC•C2osed Ctosed Tight o pgcned at Opcued at nsid
Rc�sair Ti�t ❑ nsid flsid
RP sid
The abavc is cccti6Cd w bc true.
�,��� Action Fire Pros C��T�, Allen Stevens
Firm Acl�ess PO Box 797 Waxahachie ��T��a BP0009860 � �—f/_/�
�;��g,� # 07090476
llate last securscy tested 9'23-16
White-C�tamer's Copy Yellow - City Copy Pink-Tester`s Copy
CfI�C� t�NE;
IIiRIG�TIC3N�_ DOMESTIG��� FIR�LINE�i_
BACIf�LOW PREVENTION ASSEMBLY TEST ANI►MAtNTENANCE REPORT
N�.T+.�OF PWS: �.t"?`,� � �' f c„�(,1
PWS I,D.n
LOC�TION OF SERVICE: Walgreens#04418 313 N. Denton Tap Rd.
"I'he backfl�«� preve�lti4n �sser���ly i�e2ail�d bel��w has beei7 tested al�d inail,tained as requii•ed�y TCEQ
rc���tlat:c�ns and is certiti4c�to t?e �perating «�iti�ia� acce��table ��arameters.
TYP�OF LY
Re�iuc4d Pressure Principle Pressuze Vacu�Breaker
� Uoubie Chxk Valve Au�ospherc Vacuum Brea�:er
���a��� Wilkins �� 1-1/2"
Me�del t�'umbc�, 950XL �a�d At @ meter on SE corner of property
$��N���. 533491
REDU�ED PRESSURE PRi.�I�LE�SSE:�IBLI' � PRESSiJRE VACUUM BREAb'ER
� Ds�ubie Ch�t 4a1ve�stembly
Ist Checl+. Zacf Checl: Re3icf Va1vt Air Ialet Check Valve
Irsidal Test I?C-Close� Closed Ti�t Opcaed at Opcned at nsid
Ti�t Leai:� nsid nsid
� �Dn/ R.P- a�a nsi
5�'�1 Leal:ed p7� / Did not Opca o F,eake3 ❑
�P�
aaci
Matesials
Used
Tcst At�u DG-Closcd CInsod Tight o Ogcncd at Upeaa3 at osid
Rtp�air Tight a nsid oszd
R� sid
The above is certi5cad ta be�uc.
��N� Action Fire Pros ��T� Allen Stevens
��A�� PO Box 797 Waxahachie Cat 1`estcNo. BP0009860 �� �/- f�
GBUge � 07090476 �
1)ate last accuracy test+�d 9-23-16 .
White-Customer's Copy Yellaw - City Copy Pink-Tester�s Copy