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2017_0405 C�IECK ONE: IRRIGATION X D()MESTIC FIRELINE BAc�'i.aw g�vErrr�arr Ass�L�rEsr uvn��zrtrErr�cE x�o�r NAME4FPWS_ �-r�7'`l C� (-^ Le-�(���t/_ PWS LD.x LOCATION OF SERVICE: IUI� S•�nvc�� _ Thc l�aektl���� ���eventio�l assernbly detailed belaw I�as I�een tcstcd and�naintair�ed as required by TCEC� re;ulatians and is certified to be o�eratin�r�ti'iti�in acceptable paranl�ters. TYPE OF ASSEMBLY c Rcduc,zd Pressurc Princi�Ic � Pressure Vacu�Breaker p� Daubie C�rcck Vaive C Atmosphere Vacuum Breal-�r Manufacu:re: �e-6LD Size � ��'Z� Mcxiel Number 8�'� Locaud At l�oR�{anvu�s� �aw r� Scrial N�bcr 340 4�ti REDUCED PRESSURE PRINC'FPLE ASSE;I�LY � FRESSURE V�CUL�IVI BREAI�R Doubie Check V alve�►ssembly 1st Check 2ad Checl: Retief V alve :�ir Fnlet Check Valvt Iaival Test DC-Closcd Closed Ti;ht � Ogeacd at Opeacd at esid r��u 2�� r.�.-�a 2.B � BS�a Q�a �-_ps�a �S5 �;«� a �a nat o� o r�a a �� and Maiaials t3sed T�� �c-c��a c��r��c o o��� o��a� .�a Rtpair Tight o flsid nsid RP sid The above is ceti5ed to be true. Firm I�tame /�L�on��r.e Q oS Cutified Ttsta �GScs� �,�To� Firm Address�Sac 7Q? Cert.Tesca Na.�Poo����1 Dau 5 r l�K�►..cc,4�,e '�j� Gauge # b6 I 1 oO7� llate last accurscy tested c`3 2`� (� White- Customer`s Copy Yetlow -City Copy Pi�ek-Tester's Cc�py GFIECI{ ONE: IKRIGATIQN llOMESTIC RIRELINE JC BAc��..aw rx�vErrriarr nss�LY�s�r�rm��uvrErc.a�vcE x�o�r NAME�FFWS_ t-r"?�� �'��,n���� PWS LD. # LOCATIQN aF SERVICE: I� S. `���I Thc t�aekflo���pre�ention assembty deta�lcd bela« Izas been te:stcd and maintained as required by TCEQ re���latio�ts and is certificd to be c�peratin�within acce�tablc p�raE��eters. � TYPE OF ASSEMBLY C Reduc�Pressurc Princrole � Pressure Vacu�Breaktr y� Dauble Chccl�Valve c Azmosphcc Vaeuum Breaka Manufacuuer W A�k-S Size v`' � Model Niunbcr ? Located At �F��':e Va•�•l-�'- Sa�ial Ive�mber i V Z 3 31 REDUCED PRESSURE PRINCIPLE:�SSE:�ffiLY ! FRESSt3RE V�CEIUM BREAKER Donbl�Ch�ck�alve Ass�mbly Ist Check Zad ChecG Relief Valve :�ir Fal�t Check Vsivt Initial Test DGCloscd Closcd Ti;hc .�f Opeaed at Clpened at °�d /� Ti�t �.O � L�� Z.� Q osid vsid �/a5�? RP-_psid Lca%cd a I}id aot Open 0 Leal:ed � �� aud Maurials Usai Tcst ARer DGClosed cl�r��c o o�a� o��� �d Repair Tight ❑ osid osid R.p sid The above is cerafied ta be true. Firm Name A c�l o h �r r,� f2os Cctified Testa i 1,��o n l�s��J Ferm Address Pa �u 7�i� Cat Testa Na.'�P��66SI Dau 5 � VJc�k4�c��t�C �3� (UBuge # D(c l l0�'j�j llate l�st accuracy tested a /a White-Customer's Copy Yeliow -City Copy Pink-Tester's Copy Cf�L:CK UNL:: I1�RiGATd()N -----_._._ D(�h1 ESTIC �IRELINE�_ B�.C:T�'I,QW PREVEN'I'IatV ASSEhiBLY TEST AND MAINTENAAICE REPQRT :'�'A:'v1E G�F PWS: �, ;,� £' (_ ��" "��7�<< Pu'S I.D. � -� LOCATIQti OF SER��ICE: bU S .�T� i he E,�;cklIo,� E�1����:tr„r� a����nhi�� fjet�i(�ci tie��,<<� !ta� ',aeen ?� ���..;1 ���ic� ��Zait�tair�ed as reqttired E���TCEQ Ii;[I��tti�tl� �1�ti Li �CC:t�f.'C��G ��� Q(1�C�tCt[I�.� SV�iT�ttR �tCCC[71CI�)[C ��aCEttllc?�:.C�. = Rduc�d Pressure , ��OF:�SSE:�iBLy Princ:gle - Pressure Vacu�Breaker � Dauoie Chcr.�:Valve � Atmospherv Vaeuum BroaL-er ,�fanu�acaue: �-�S 3�4,i Siz� Mode:'�i�ba _ Gth r„Gc�a(a�I(,� T ,.ocateC�t _ L�r VaK\ S s�����: u ti,�.�1�b(.� ; 1 REDI;CED PRESSLrRE PRLNCTPLE:�SEl�LBL�" C PRESSU-RE�%���gp;�R I ` � Doubie Chec.k�'alve;�Ssembly � j Ist C3eck 2ad Chec� _ � , Relie€4 alv� �ir Initt Chtek Vahro ' Iuiaai Tcst ' �GCIosad Cios�d Ti�t �i �; � Ti�I J. C f �,` Lcaked u �ed at OPcned aL nsid i{ �S7 j �-_�std �. � �sid ___,oszd �-� - ! �� LI � f Ihd aot Qpen p j� � ' � j � � {�d i � �fattrials ! f Uscd � Test Af�er DC-Clased CIosed Tie,�t Q �P� Ti�ht o �P�ed ai Opcned at �;� , Rf' sid � ---�nsid __�osid --� T'he above:s ccZibe�yp bC� �llIIl N3ITIG�}C�"/p in�l ro f rt O � Cer�fied Testa _UQ,so„ ��••3�b„� Firm Address PD �e Y '7 ti'7 Cett Testet No. d0(D 6 S/ wa�� (2a c l.,c.c --�-k Datc `�/ /�7 :sauge # _ hlr I 1 ov�5 ��te Iast accuracy tested 8 Z �.y , I White - Customer's Copy YeIlow - City Copy Putk-Tester's Ccx�v