2017_0630 C�IECK t�NE:
IHRIGATION llOMESTIC FIRELINE X
BACKFLOW PREVENTION ASSEMBLY TEST AND 14fAINTENA1vCE REPORT
NAMEOFPWS: ���J �l �' r [r-,n��«
PWS I.D.� a57oa�o
LOCATIOIv OF SERVICE: `�"�'y�D[,/Gt�
Tl�c backilo���prevention assembly detailed belo«�I�as been testcd and maintained as required by TCEQ
re�ulations and is certified to be opeF•ating�vithin acceptable pai-ameters.
TYPE OF ASSEMBLY
o Rcducrd Pressure Princroie � Pressure Vactn�m Brealaer
� Double Chccl:Valve c Atmosp�ac Vacuum Breatctr
M���
�it�G�E s' s� B `,
Modei Number ��� Lacatcd At /V0�� VObI���
s��N�b� /le5�,.�
REDUCED PRESSURE PRINCIPLE ASSE:I�LY ! PRESSURE VACUi]M BREAI�R
�r poable Chetk Valve Assemblv
a ��
Ist Checl: lnd Checi: Retief Vatve :�ir Intet Check Vaivt
Iniaal Test DGCIosed 3•o Closed Ti;ht � Opened az Openai az _,_gsid
r��c � r�� � Z❑ �s�a oria
RP-__,psia
Leai;ed a Did aot Opea o Leal:ed C�
�P�
and
Materials
Used
Test Afier DGCloscd CZosed Tight ❑ Optaed at Opcaed at nsid
_—�
Rtpair Ti�t o nsid nsid
RP sid
The abova is catified to be tnu.
Firm Name t1 C�'l b`1 t�I r.� �2n� _ Ce�rtifiod Testa I �Sh r! HVSTb�I
Firm Address l'�'+6Q� 7�7 Cert.Te�tt Na DD/D�Date_��1�
��tk�i.LlkGLr.[.L �X
t�auge # �!P!l0(�7�j'
llate last accuracy tested � 2 ��
White- Customer's Copy Yellow-City Copy Pink-Tester's Copy
C�IECK ONE:
IRRIGATION DOMESTIC FIRELINE
BACT�'LOW PREVENTIQN ASSEMBLY TEST AND MAINTENANCE REPt}RT
NAME OF PWS: ���?`/ G'' (-' �r(����i
PWS I.D. � d,5�(O�b
LOCATION OF SERVICE: y�� . S �/COur'�
The backtlow prevention assemhty detailed bel����l�as been te:s�cd and maintained as required by TCEQ
reVulations and is certificd to be o�eratin� �t�ithin acceptable p�rameters.
TYPE OF ASSEMBLY
� Reduc�Pressure Principlc � Pressure Vacu�Breaka
� Dauble Check Valve e A�ospherc Vaeuum Brtaker
Ivtanufacturer l.t/Ga�S size -3/L�r�
Model':vumber d0 7/ti/ Locaud At � /V O�-� ✓����
s��N,�bc� 32 0 23
REDUCED PRESSURE PRINCIPLE ASSE:t�LY I FRESSURE V�CULJM BREAKER
Double Check valve Assembty
l�l,✓' lst Chec!~ 2ad Chccl: Reiief Vatve :�ir Inlet Check Vaive
Initial Tcst DGClosed r.g Closed Ti;ht �t' Opened at Opmai at nsid
Ti�t � LeaI:ed 2,� � osid osid
RP-__gsid
I.cai;cd o Did not Opea O Leal:e� a
�P�
and
Maurials
Used
Tesc Af3er DGClosed Closed Tight o Qpeued at Opcaed at nsid
Repair Tight o nsid osid
R.P sid
The above is cetti6ed to be tiue.
Firm Namc �Gd'IOV� �1�'L 1"R.d-S' Certificd Te.sta V�So h s-rn� _ _
�
Firm Address,P� ��C 7�7 Cert Tester No. ��b�S Date-S`;�-,�-f=-�
�jlf C�.ka f�-c�c-�,�� ��c
(Uauge # �UQd?�j
llate last accuracy tested
W"te- Customer's Copy Yellow -City Copy Pink-TPster's Copy
C�IECK ONE:
IRRIG ATI�N�_ DOMESTIC FIRELINE
BACKFLOW PREVENTION ASSEMBLY TEST AND hLAINTENANCE REPORT
NAME�FPWS: ����`l �' F` r,j���-[�
pWS I.D.# �5700 �f b
LOCATIOIv OF SERVICE: S�
Thc backilo��� pre��ention assembly detailed belo���has heen tested and maintained as required by TCEQ
regulatians and is certified to be operating�vithin acceptable para���eters.
TYPE OF ASSEMBLY
❑ Reducrd Pressure Princivle � Pressure Vacutmm Breaktr
,� Double Chxl:Valve c Amiosphctc Vacuum Breaker
Manufacturer W�lkrNs� Siu Z�
Model Number 3S0 Locatad At �o k-l-t� ��u h E� .S�►+�t_-�
s��N��� �41359)8
REDUCED PRESSURE PRINCIPLE:�SSE:I�LY ! PRESSURE VACULTM BREAI�R
Double Ch�tk Valve Assemb}v
G55
lst C3eci: Znd Checl: Relief Valve Air Fnlet Check Valve
Inival Test DGClosed 2.� Closed Ti;ht � Opeaed at Opeued at nsid
Ti�t �Q Lcakcd ❑ �sid �sid
RP-_psid 2•2
Lcai:ed a Did not Opea O Lealed Q
�P�
and
Materials
Used
Test ARer DC-Closed Clased Tight a Opened at Qpeaed at nsid
Rtpair Tight o osid osid
R.P sid
The above is ccti6ed to be ttve.
Firm Name �+(�.�1n�ir.e�i(9S Ceetified Tester /�.S"oa �'�'aJ
FirmAddress �� �ok 7'�l7 Ccrt.TesurNo. ��501065 ( Dau__�2��' /
w�ix�.I�a��►.<<.c T-ti
G�uge # d�o� 0 d�5
llate last accuracy tested 8 �
White- Customer's Copy Yellow -City Copy Pink-Testet's Copy
C�IEC� �NE:
IRRIGATIQN DOMESTIC �! FIRELINE
BACI�LOW PREVENTI4N ASSEMBLY 7EST AND h(AINTENANCE REPORT
NAME�FPWS: ����`l �} � Lr•(���-t/
PWS I.D.n b S 70� �0
LOCATION OF SERVICE: ��S- S �a��
The backflo��' preventian assembly detai}ed belo�� has been trstc�t and maintained as required by TCEQ
re�ulations and is certiticd to be operating Fvithin acceptable paranleters.
TYPE OF ASSEMBLY
❑ Reduc�d Pressure Pnmciglc ^ Pmsure Vacuum Brealadr
�1 Dauble C�ccl�Vatve c Atmosp�erc Vacuum BreaL�a
Manufacturer �it�l �I►v S Size
2 "
Model Number �J' � Locaud At ��.��,( 4�,.-n � S��h�
Serial N�brr
REDUCED PRESSURE PRINCIPLE:�.SSE:�IBLI� ( PRESSURE VAC[nJM BREAI�R
��" Double Ch�tic v alve Assembly
�J
lst Check Znd Chtcf: Relief Valve :�ir Fnlet Ch�ck Vaive
Iniaal Test DGClosed �• Closai Ti;ht y�f Opeaed at Opened at vsid
Ti�t 1� I.cakcd ,L 0 ❑ nsid osid
RP-_psid
j,�;� p Did not Opea O Leal-ed O
�P�
and
Mauriais
Usai
Test ARcs DC-Clased Closed Tight o pptned at (?pcncd at nsid
Rtpair Tight Q nsid nsid
RP sid
The abovc is certified to be true.
Firm Namo�dv► �(ke �S Ccrtificd Testa �QSok [ s�re�l
Fiim Address,��0 �s� ?Q7 Cert.Testa No. t`�P6o 1 D� S J Date � 30 /7
{�/�.ka k�c k�e 7u
c�auge # d(j/Do 7S
llate last accuracy tested 8 2
White - Customer's Copy Yellow-City Copy Pink-Tester's Copy