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2017_0615 CFIEGK ONE: Lt�,RIG ATION J_ DOMES`IYG FIIZEL�NE X BACI�LOW PREVENTIt}N ASSEMBLY TFST AN� C�R�roRT NAME OF PWS: �`�` � � �- ` PWS LD.n LOCATIQN OF SER�IICE: Tii�l�..r�tlo�����reventic»} assemt�l} detailed belo�t I�a�been t�,�cci and enaintained as requtred by TCEQ rc�tulatit�t�s attd ts certtfed ta be operating�E`tthin aceeptab(c p�raEtteters. TYPE QF ASSEMBLY � pressurc V acuum Brr� � Rcduc�Pressurc Piiacmic � A�o��Vacuum B� �' Dauble Chxk Valve l�l�.l�-S sru 3`�f ` �����: � r������ o��µ� ���� �'w U�� I _ s«����� �R�� REDUCED PRESSURE FRI�+IC'fPLE:�SSE:�fBLY � FRESSLtRE V3CEFUM SRL•AI�R ��� Doubt�Ch�ck�alve Assembiy Ist Cbeck Znd ChecL- Reiicf'�alv� 3ir Inlet (�tedc VaIv� Clos�d T�i Opeae�� dPeacd at ----�� Ini�al Tcst DC-Ctoscd f g � vsid Ti�t � Lealsd �,()Q �sid RP-_-Psid I}id nat Ope�t D L� � Lcai;cd e �P� and Mztc�aIs - Used CtQsed T'rght o ��� ��� r'""� Test Aftet DC-Closed Dsid osid Rcpair Tighc � gg sid Thc aba��e is ccrti6t�to be tnu. ,,� 6 S Ccrtificd Tcsta �QSov► �v�`tv� F'irm Name �-!'�orn ��Y (Z._—.- u '7 Cert.Testa No.�POO\�S 1 Dau_� Firm Address�� (�axq ka c,1�uz. T� Gauge # ��a l t oo`��j llate last Securacy tested�� � Yellow-City Co�y 1'utk-`�est�'s CoPY White-Customer s Cc�py CFIECK ONE: IR.RIGATION D�IVIESTIC �C FIRELTNE BACI4LOW PREVEN'TIQN ASSEMBLY TEST AND MA1�ITENANCE REYORT NAME�F PWS: L��7` C' (' c, _ PWS LD.# LOCATIOIv OF SER�TICE: "['he backilo��' pre�,�ention assembly detailed bela�{ has been tesa�a aed�r►aintained as required by TCEQ re�ulations and is certitied to be aperating�vithin acceptable p � TYPE OF ASSEMBL��Vac�m Brcakrs a Reducad Pressure Princivie c Atmospbae Vacuum Broaker � Double Cher.�Valve u Manufacuzrcr I,t 1�-�-�=5 Siu I,acatcd At � I r_ .�.��ar�u Q ��� tvt«iel Numba _ DO 1 _ s��N�,� 11g5'7 2�l REDUCED PRESSURE PRINCIPLE:�SSE:�ffiLY � PRESSURE VACUTSM BP;EAI�R Double Check Valve Assembly Q SS Znd Ch�cf: Reliof Vatve :�ir Intet Chedc Valve Ist Check � osid Initial Tcst DGCloscd 2.0 Closed Ti;ht �d' 4Pcae�at �� psid T�� � r.� �.g o �s� Rp________psid Did nat Qpcn O L� � I.cai:ai � �� aad . Maurials Used Closed Ti�t o Opeatd at Opcned at �� Test After DC-Closed DSid DAd �p� Tight ° gp sid Tho above is cerafied ta be tnu. II � 6 S ����� � A Sov► �I—lu ST�+J Firm Name Fum Address u � -- Cert.Tesur Na.`aP�01�51 � � (l�0.xA�,Q C.1�tQ.. Tk� Gauge # ��a l t O o��j llate Iast accuracy tested�2� , Yellow -City Copy Pink-Tester's CoPY White-Customer s Copy C��ECK CSIdI�: IKRIG Ei'PIC}N DQMESTIC FIREI.�IiE sAc�.ow P�v�rrr�arr AssE�r.Y�s�r��Au�rrEx�+xcE�� NAME 4F P�IS: ���` � � .�, . PV�IS LD.# LQCATIQN OF SERVICE: Tiic t�acktlo���pree-ention assembl�� dztailed belo�ti has been t��ar�ie�r�a�ntatnecf aS rec}u�red b}j TC�Q revu{au�,ns atic� is eertitred tc> be op�rating«�ithi�l �eeeptable p TYPE QF ASSE�'viBLY � pressurc Vacznm�Breaker e Rcdnccd Pressurc�lc � Atmc�sphcc Vacuum Bnaka � Dan�ie Check Valvc B�, �����: i��d-�-s �� a �AA ���t Sw UQu.I� t�����b� ���-- s���;�� Gv0 l?�_____ REDIICED PRESSi3RE PRINCFPLE:�SSE:KBLY � PRESSURE V?�CULTM BP;F� Doubte C�eck�%a1Ye�Ssa°bty a c� c�va�►� Isc Check =ad ChecL: Relief Valve Air Ia[et Clascd Ti�t /!� Opeaed� ��� � taiaai Tcsc I?C-Closed'.�•� ,� Q 4sid n� Ti�tt �-�� 2 — RP-_-Psid F}id noc Opca o L� � I.ca;;cd c �� and ;�rfaterials - Usai Test Af�er DC-Closed Ctosed Tight o Qpened at ���sid �� �� Tight � osid p�g sid The above is certifiai to be uue. � �6 s c�s�r� Jason ��s-c�+� _ �tFIli KaII1C ��'�t r�Vl 1`� �- �/�� Firm A�s u. � c«t r�x�.`3Poo��s� r�-�,�=�.. (No.xa I�a c.Ltc�2 T� c�auge �, �� 1 t o0~(�7 1)ate last accuracy tested� 2 White-Customer's Copy �ellow- City Copy Pink-Tester's�opY C�IECK (UI+IE: IR,RIG ATION DOMESTIC X FIRELiNE BACKFLUW PREVENTIQN ASSEMBLY TE.ST AND 1�►���CE REPORT NAME QF PWS: �-� i � � � r - PWS I.D.» LOCATIQN OF SERVICE: � ���� Th� l,•arkil��«�pre�ei�ti�n assemhl}� detailecf bcto�t ha� been t�;.cct and maintained as re uired by �-��rulations and is eertiticcl tc�h� Qperatin��irithin �}eeeptable garaitteters. TYPE O�ASSEMBLY c Reduc,�d Pressurc�le � Picssure Vacsnnn Stesbet �'' Dauble G����`� � Atmospherc Vacu�uu Breaker Manufacturc: Sizc Z�� ������� 007 l�l ����.� X�>v S o x s��N�v� � y�f � 1�D REDLICED PRESSURE FR�ICIPLE ASSE:�ffiLI� � PRESSLTRE�ACE�[JM SREAI�R S Daubic Checic�aive�Sstmblv t�S Zad C�ecL- Retief F alve :�ir Inkt C6ecic Vatvt lst Checi� Ctosed'L'i�hc J� opeued at Op�at � ��r� Dc-c���a 1,8 Q �S�a o� rr� � � /.� - RP-_-.Psid Did ac�t C}pe� c� F.eai�d � �;� c �� aud INaurials - Used Tcst ARc.c' I}C-Closcd Closed T'rght o Qpcucd at 4����� -----�� �� Tight 0 4sid gp sid The abave is catifi�to be tnu. _ p ,,� 6 S Ccrtified Tata �QS�i� �c�STv rJ -- F"um 2�Fam� f rC�ut� ��Y �. Fum Address �t � Cert.Testa l�to.`aPb01�S1 Dau_� (Na�w k�.c,1�c.e. T� Gauge � �(p I l oo��j llate last accuracy testec� 2 , ��.ow-city copy Pink-Tester`�CoP3T White-Customer s Copy C�IECK ONE: IRB.IG ATION � DUMESTIC FIRELINE BACI�FLC}W PREVENTIUI�I ASSEMBLY TEST AND MAu�NANCE R�P'E�RT NAA�IE 4F PV�tS: �'�.r `l C' �' f c-n� -'r PWS I.D.� LOCATIQN OF SERVICE: T�ic l�arl:tlo«��re�entior� asse�z�t�l� detaitzd belo�t Ilas been�t�'�ar��Ze�maintained as required tsy TCEQ r�<Tul�lic�nti aczd is ccrtiY�cd to be c�peratin��«-ithitl acce�tabl � TYPE OF ASSEMBLY g Rcduc,�i Pressurc Prin�it�ic � F�cssurc Vacuum Sz�ataer � Dou�le Chcck Valvc C Atmosghere Vacuum H�ataef r�����: t—r�.� s:� .L►r r�����b� gsb ���.t I,vi�'� ox s���;� � D l!l�_____ �D��D Pg�g��tE gRLNCIPLE:�SSE:�LBLY � PRESSURE��CLTUM�� Doubi�Check�alve Assemb[y a7� Zad ChecL' Retiaf'v alve :�ir Iai�t Cbeck Vah*� Ist Cl�eck Closed Ti..ht C1� 4P��� ��� � Inizial!cst I�-Closcd 2.� L��� 2 a osid �� Ti�t $� • Rp_______psid p � =� c Did aoc Qpea L.eai:ai �� a�d Mauriais � Uscd Ctosed Tight o Qpeaed at �� .� Test Af�er £}C-Closed Dsid nsid �p� Ti�t a gp sid The above is cetified to bc true. ,,� S Cctificd Tata �QS�in �-v STv rJ ____ F"sFm I�tamc r�-r�L,•,,, C„� 6 • Add�ss �u '7 i Ccrt.Tcstu No.`aP001�S 1 Date_� Fum (Na,�ka c,�,.v2 Tk c�auge # �� 1� 00�5 _ I1ate Iasf accuracy tested 2 , Yellaw -City Copy Pink-Tester`s�pY White-Customer s Cc�pY CFIECK C}AIE: � IRRIGATIEIN DQMES`IYG FIItELiNE BACK�'LUW PREVENTIQN ASSEMBLY T�.ST AN�MAl[����� NAME OF PWS: ��i`l C� C� C c-���e/ PWS I.D.n LOCATION OF SERVICE: Tlic har1;41o�v�reventioi�as�emhly detailed�el����has bee��"ara�e ers.aintained as required 6y TCEQ r���ulati��ns and is certitied[o be aperating«-ithtn acceptab P TYPE OF ASSEMBLY � Rcduced Pressurc��lc � Ptcssurc Vac�ntm B�ea� � Dauble Clzcc�Valvc c Atmasghcrc Vacttum Hteaket �����: /.�/a�s' s� `3`y�� I.ocar�cdAt f;.... �..�._ /� r����,mmb« O�7 M Z - --- s��N�� �`�G / — REDUCED PRESSURE PRI�ICIPLE:�SSE:KBLY � PRESSURE�AefFUM BREAI�ER Doubte Chcck�%alve?�ss��iY �[s� 2ud QzecL- Reli�f�alve :�ir Inkt C�eeck VaIve lst C�ecl� closed Ti�c .�f Opeaed ai �t�at �---� Inival Test LaC-Closcd�. L` nsid T��c '� L� �,2° �Si� Rp__psid Q �ced � �;� c I3id nat Opea �F� and Ivfatctials - Usa3 Test ARcr DC-Closed Ctascd Tight o Qpeaed at OF��� ---------� � DSIC� Q� g,�p� TigEtL Rp sid ' The abave is ca�fie�to be tnu. ,,� �6 S CcGtifiad Testa �QSoir� �u STc�tJ �"um Namc ��L�: • �`� 2__, Firm?►ddress��1� � c«c.r�xo.`3Poo��s 1 �–��-�.` wa�ka�.� T� �8uge # o� �� oo-�s llate Iast acctiracy tested__��_ , ��u.ow - c�ty co�� �-�rest�� White—Customer s Copy �x�cx ox�: IRSIGATION DQMESTIC FIRELiKE BACKFL4W PREVENTION ASSEMBLY TEST AN� ��� NAME OF PVSIS: �-��'t � � F' l c�(�C��<<_ PWS I.D.n LC}CATIQN OF SER�'ICE: � ,d and cnaintained as requ�eci�}j T��Q Tlic t��acktlo«�preventio�l asseEn�I�� detailed velo�t has been tc�«. r��i�lat:�ns a«d is cet-titEed to �e aperatin��r•�th�il acceptab�c pat-a�t�eters. 'fYP�QF ASSEIvfBLY C Rtduced Pressurc Princiglc � Pressurc Vacu�m Bzeaiacz Dan�le Chcr.I�Vatvc c Atmasphac Vacuum Bieatars � �b �► ��,����: �,r Ja t s� I �( �,11.�� ���� �,� Model'_vumber �77 — L.ocat.�d At �_ — Scrial Ntunbcr ld Z�c`�� — REDIICED PRESSiAtE PRP.�ICIPLE A.SSE:KBL� � PRESSURE��C[FUM SREe�I�R Doubt�Ch�ck�alve�Sset°bf� �! � Ist Cf�ec�: Zad Ch�c1: Re4i�f Falve alir Inlet C6tdc Vatve Closed Tia at Opened at � Inival Tat DC-Closed�.2 '� � �� Qsid Q� Ti�t � � 3•� – Rp______--�sid p � � �ia IIOE�C'a �..C31�G� C iw�� �� �cV�3LGL'f3�.S - USG� TCSL E�Cf �-C1QSCC� �OSC�T2�lt 0 �QGQCd di ��QSL� � �p�- Ti�tt O DStd Rp sid Tha above is certifia3 to be tr�u. n ,.2 6S Catificd 7csta �/QS��t u STv� — FirmPtame f-� '�04� ��`! Q- Firm Address�h �'� �a� _ Cut Testu No.`aP�01�5 t Dau'� (Naxa k�.c.k cr�. T� Gauge # ��a 1 t OO�j�j llate Iast accuracy tested�4�� _r�_�� White-Gustamer's Copy �ellaw-City Copy Fink-`�ester"s CoPY GFIECK Ul�IE: IRRIGATION DOMESTIC FIRELINE sAc�.aw P�vErrrtax Ass��Y TEsr�n M�TErr�rcE�� NADrfE OF PWS: �� ► ` ��� c- _ PWS I.D.� LQCATION 4F SERVICE: uired b TC�Q T�t� hacktlo���preventic��� ass��l�bi} detailed b�i ci 1 acce�t bic para ne�r laintaiMed as req � r-c<rulations attd is eertiticd te� E��operatttt� P TYPE dF ASSEMBLY � Pressurc Vacu�mm Brcalmr c Raiuc�i.Fressurc Pnmcicmic � A�o��Vacu�Bncaker � Danble Chcr.��aive ��� Manufacturer /A,/s�S ��`` '—— ������ �,,� �P�aha� S�-�_ s���;,�,� 197q59 REDL'CED PRESSURE PRL�ICIPLE:�SSE:KBLY � FRESSURE V�CE)UM SR� Double Chec.k�%ai�'e��bEv /j rj� � �alvc �ir Initt C6edc Vaiv� (n, lsc Cberk ..ad Chec�: Keti�f � Closed T�i�tt �. 4pened at ��� � Iniaal Test DC-Closod 2• � Lc� 2.Z a Qsid o� Tiahf � RF-�Psid Did not Open C1 Ix.aled �;� C �� and Materials . - Usai Test After DC-Cioscd Closod Tight o ��� Sid ���nsid �� RcPair Tig�t � Rp sid The abov�e is Ccc't�fied IO bG mu• ' I r2 6 S Ccr�ficd Tata QSoir� }�u Stv tJ FiFm l�tame ��-'�''ot< <� �._--- /,�/�� Fiim Address h � c«t.r�xo.`3Poo��s� �—(���`' wa�ka��. T� c�auge # ��a t t o 0�1�7 llate Iast accuracy tested Z White-Customer's Copy Yellow -City Copy Fuek-Testet�`s�oPY