Gateway BP(1.5)-LR000708CHECK ONE:
LRRIGATION DOMESTIC FIREI,INE
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTE.,'Y~CE REPORT ~
C . eX' Connie_ii ,
I ! I '
PWS I.D. #
~ b~ow p~fi~ ~s~bly de~ ~low ~ ~ ~ ~d ~~ ~ ~ ~ ~CC
TYPE OF ASSEMBLY
/ , l~duc~ Pressure Princ/plc m ~ Va~ B~
~le Ch~ V~vc ~ A~o~h~ Va~ B~
s~s~b~ ~ 5 q OV
I~£DUCED PRESSUR~ PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKI/K
Double Check Valve Assembly
I ~-nd Check R_dle_fVn]ve .&ir Inlet Check Vnlve
1st
Initial Tezt DC-CIos~ /Closed Tight ~/ Opened at C)p~ at psid
Ti.~ht ~ L~aked n ~sid psid
RP- psid
I.~k~d ~ DidnotOpen m Le. ak~ ~
and
Martials
T~'t ARa' DC-Closed Closed Tight n Opened at Opened at ,psid
Rrpair Tight m psid usid
RP psid -
The above is certified to be true.
F~A~ Leo~,~v, t~C, I~/~ ~T~No.~D~
Date last accuracy tested
CHECK ONE:
/
IRRIGATION DOMESTIC FIRELINE ~
PWS I.D. #
LOCAT O S V CS:
!
Thc hallow pr,~v~ion ~=nbly d~tail~l l~low 1~ I~ ~ ~d ~~ ~ r, qui~ by.
r~.~ml~iom and i~ ea-fiti~l to be ol~rari~g ~thin acc..~ptable param~'~.
P.~iuc~ Pressuru Principle
Double Check Valve
TYPE OF ASSEMBLY
m Pr~ssur~ Vacaum Bmakcr
m Atmosphcr~ Vacuum B~
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAII~R
Double Check Valve Assembly
ls~ _Check 2nd Check R~lief Valve Air Inlet Check Valve
lmual Test DC-Closed Closed Tight e~Op~d at Op~ued at psid
Ti.~ht ~ L~cl m psid psid
RP- psid
_L~_-ed m Did no~ Op~ m ~
Materials
U__~_
Test ~ DC-Closcd Clos~xi Tighl cl Op~x[ at Op~ned at psid
R~air Tighc o psid psid
KP psid
The above is cer~ed to 1~ true.
Date !~-~t accuracy tested
~ita ('~.,,,:fnm~,e~_~ ar, nv Y~.llnw Oitv ~.r~v Pink -T~ter~ Couv
CtlECK ONE:
IRRIGATION
DOMF_~TIC FIREUNE /
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
~ o~ Pws: C_~, ~- v ~
/
PW$ I.D. #
7 50
C o i -T'x.
I I J
The b~dlow prevention ~ssmbly d~r~iled b~low h~ ~ ~ ~nd ~~1 ~s ~ by. TNKCC
r~.c, ul~ion~ ~cl is c~x~fi~ to b~ operating ~thb ~p~bl¢
TYPE OF ASSIEMBLY
P,.~uc~l ~ Princ/pl¢ ~ lh'~sum V~'t,u~n Br~r~
~uble C~ V~vc ~ A~o~h~ V~ B~
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM
Double Check V~lve Assembly
I 2nd Check ~_.ile[Valve A/r Inlet Check Valve
Initial Test DC-Closed ~Closed Tigh£ ~' Opened at Opened at psid
p,.P- .psid
t__~k~d ~ Did not Open ~I Lcak~l
Matm-ial~
T(m Af~ DC-Clo~ed Clos~I Tight c~ Opm~ at Opm~ at psid
P,~ir Tight a psid osid
RP psid
Whit~ - I~.llqtom-~.tq C. nnv yellflw - ~itv Cflnv Pink - Te~ter*.q Cony
CtlECK ONE-'
IRRIGATION
DOMF~TIC FIRELINE
BAC/~'LOW PREVENTION ASS~LY TEST AND MAINTENANCE REPORT
I I I
?WS LD. #
/
TYPE OF ASSEMBLY
/ l~iuc~d Pr~ssur~ Principle =
_ Double Check Valve =
Manufact=~' (~ 6~-(?", Siz~
Model Number (~ ~--7 Located At
Pressur= Vacuum Bruakm'
Atmosphere Vacuum Bruak~
C r'r er" e+er'x)
I~£DUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACU-GM BREAI~I~
Double Check Valve Assembly
1st Check 2nd Check L~ief Valve Air Inlet Check Valve
Inkial Test DC-Closed 'Closed Ti~t ~/ Opted at Open~ at psid
Ti_~h~ ~ L~ak~l a ~sid psid
KP- ~sid
L-~l ~ Did not ~ m ~
Martials
T~st Af~ D~-Closed Clcs~ Tight m Op~m~ at Op~n~ at psid
P~'pair Tight ~ psid psid
RP p~ia
D= '7--' ~-C~
Date last accuracy tested ~-~ - I ,~ - C~)
White..- P.n_etnmol.%~ C. nnv Yollnw - ~.itv Cnnv Pink
CHECK ONE:
IRRIGATION DOM~C FIRELINE v//
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
~ o~ Pws: ~ t- ~, o~c C~e I I .Tx.
[ I I ·
PWS I.D. #
LOC^~O~ O~ S~WC~: '7.~
!
r~dafiom and ~
TYPE OF ASSEMBLY
Si=
Locat~l At
Pressure Vacuum Break=
Atmosphere Vacuum Break=
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VA~ BREAKER
Double Check Valve Assembly
-
1st Check 2nd Check Relief Valve .~ir Inlet Check Valve
Imtial Test DC.Clos~ Closed Ti~t C2 Ol~n~ at Op~n~ at psid
Ti~ht m Le. ak~i c~ psid psid
RP- psid
L~aked ~ Did not Open
and
Materials
Used
Test AP, er DC-Closed Closed Tight r~ Opemed at Opted at psid
Repair Tight u psid psid
RP psid -
The above is certified to be true.
FirmA~klre~ .Le~,.e~v;l(e.'"T~.-/~ C~t. Test= No. ~ Date ~7-~
!
Gauge# r~ o'~O i(oQ' '7 !
Date last accuracy tested
W~t~ - ~tomer's Coov Yollow - City Coov Pink - TestePs Coov
CHF. CK ONE:
IRRIGATION
DOM~C PIREL~NE '/
NAME OF PWS:
PWS I.D. #
LOCATION OF SERVICE:
Th~ backflow prm,~nfion assembly detailed below k,~ been tesu~ and ~ed as r~luired by. TNRCC
r~_~l~ons and is c.~ified to be operating wi,hl- acceptable paramctrrs.
Manufacturer
Model Number
Serial Number
Double Ch~k Valve
TYPE OF ASSEMBLY
~- Pr~s~ Vactmm Brealm-
[] Atmosphere Vacuum Breaker
Size ~)/~( ~t
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSU'RE VAC'I.ffffM BREAKER
Double Check Valve Assembly
Ist Check I 2nd Check t Relief Valve Air Inlet Check Valve
Initial Test DC-Closed Closed Ti~t ~/' Opted at Opemed at psid
Ti~a~ ~/ m
_ Leaked psid psid
RP- psid
~ o Did not Open m Leaked ~
Materials
Used
Tcst A.e~r DC-Closed Closed Tigh~ o Opened a~ Opened at psid
Rcpa/r Tigh~ o psid , psid
KP psid ,
Thc above is e.~rtifi~d to be true.
F~A~ ~r~]qV~(~7~ C~T~No.
Oauge #
Date last aCCUl'~C~ tested
White_ - ~.,,_~tnm~_e'.q ~.nnv V~llow - City Cmmv Pink - Te~terk~ Coov