MacPlaza 1 Sun-LR 961005CIIECK ONE:
IRRIGATION DOMESTIC FIRELINE~
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: ~,v PPec ~
PWS I.D. #
~9~
LOCATION OF SERVICE:
~Jd ~ ~
The bacl~low prevention assembly detailed below has been tested
regulazions and is certified to be operating within acceptable parameters.
and maintained as required by TNRCC
TYPE OF ASSEMBLY
^ Reduced Pressure Principle ^ Pressure Vaevrmm Breaker
~' Double Check Valve ^ Atmosphere Vacuum Breaker
Manufacturer
G/P7'/ 5
Model Number ~D~ .~,C/ ~ ~
Serial Number ~ ~ r`1 / 7
~,~•
Size ~A ,(j
Located At /~/ ~ ~~ 1n7~+/a - ~oOD ~ /+/ e/t /t 1~~6v'~
nr WcS~f/~
UrV gt C ~ S~ Llr S7i~~16E
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER
Double Check Valve Assembly
!
,'
1st Check
2nd Checl:
{ alve
Air nlet \
Che \ V ~ e
Initial Test DC-Closed Closed Tight ^ at Open a sid
Tight ~, Leaked ^ sid sid
RP-_pstd
Leaked ^ Did not ^ Leaked ^
aus
and
Materials
Used
Test After DC-Closed Closed Tight ^ ed at at sid
Repair Tight ^ id sid
RP sid
The above is certified to be true. ~7~~7D~ ~S~ ~~ W A?~S DOS ~ 1 3~a " H ~,a~ 3
Firm Name t'I ~i < ~v~rt/G A9 i~- Certified Tester _ til P-c.~~ ~,i~rt ,.J ~~
Firm Address h-~ ~ ~ yr ~r~~ ~ ~i6y~
Cert Tester No. ~~ 176 y~ `~ Date ~° s 86
Gauge # ~ l b l O
Date last accuracy tested ~ ~ t y
White -Customer's Copy Yellow -City Copy ~' Pink -Tester's Copy
s '°
-. '~ CHECK ONE:
w IRRIGATION DOMESTIC ~ ~ FIRELINE
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: ~ ~~~ C c
PWS I.D. #
LOCATION OF SERVICE: /~%/~ l >~,,;. /dvo ! /v ~/dP.rCyASt'- ~w`-3~ y
S~,r 5~.~~°'
The bacl~low prevention assembly detailed below has bees tested and maintained as required by TNRCC
regulations anti is certified to be operating within acceptable parameters.
TYPE OF ASSEMBLY
^ Reductd Pressure Priaciple ^ Pressure Vacuum Brcaka
~v Double Check Valve ^ Atmosphere Vacuum Breaker
/ \ ..._._
/ i- _ .._ / ~ -- rv-_
Manufacturer ~,U ~ 7 ~ S _ Size .. __.
Model Number (~~//t'1 C%~J ` Q ~ - -_ Located At -; .
Serial Number ~~ 10'3 I _ .°
REDUCED PRESSURE PRINCIPLE ASSEMBLY
. PRESSURE VAC UUM BREAKER
Double Check Valve Assemb
~'~._ ~
_, ~_.
1st Check 2nd Ch - ..: .Relief Valve '~#ir Inlet Check Valve
Initial Test DC-Closed Closed Tight ~ ed`at 8p ed at sid
Tight ~ Leaked o p id "°` sid
RP-_,psid
Leaked ^ Did not ^ Leaked ^
~p~ __. :r
and ~
~
~ ,~, .....
~`
Materials ~~ d ~ I ~' _
Used -
Test After DC-Closed
~ Close~ght ^ ed at Opened t asi
Repair Tight
^ sid esid
RP sid
The above is certified to be true. `
Firm Name ~`'~ is/''~,~ Cst.~ ~/~Lfal~v~~ Certified Testa '"~~''`~~ ~ S
Firm Address ~ ~ ~ ~ ~iw ~S~ %~... Cat Testa No.~) f 7~ S`e~ Date ~O S s ~
Gauge # ~> U/ iJ i U
llate last accuracy tested > ~ ~
White -Customer's Copy Yellow -City Copy Pink -Tester's Copy
M
y
CiiECK ONE:
IRRIGATION
DOMESTIC ~`-~
FIRELINE
BACKFLOW PREVE/NTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: ~~` ®Ct
PWS I.D. #
LOCATION OF SERVICE: ~ ~) ~ A;t 7 dit ~~` ,1/, 2i /~ ul~~ Su. v~GC ~ -~~~'AGc
The bacldlow preveation assembly detailed below has bees tested and maintained as required by TNRCC
regulations and is certified to be operating within acceptable parameters.
TYPE OF ASSEMBLY
^ Reduced Pressure Principle ^ Pressure Vacmmm Breaker
Double Check Valve ^ Atmosphere Vacuum Breaker
__._..
_ ~ ~ j~-r`r----~
Maaufacnuer ~A ~ ' ~ Size`.: !
p~'1 m~-Q~ ~ ~~~, __
Model Number -.~` Located Ai^-~
Serial Number ~ ~ ~~ ~ .. _~; - ~:- ~--~.
.~:
__._~
REDUCED PRESSURE PRINCIPLE ASSEMBLY FRESSURE VACUUM BREAKER
Double Check Valve Assem~~" ~.: ~ ~ `~
_.J
t
._.-,
~
1st Check 2nd Chedc~ ; ,Belie halve ~'r nlet C~ ck Valve
Initial Test DC-Closed Closed Tight ~:` Open at ! ea at sid
Tight ~ Leaked er ` id id
Rl'-_psid _ ~ '
Leaked ^
:~ ~d not en ^ ^
Repairs --"° ,
and ,~ / ~
~ - '
,
Materials ~~ ~ V" ~~
Used
Test ARer DC-Cl Clos Ti t o Open at Opea at sid
Repair Tight ~ ^ st si `
RP std
The above is certified to be true.
f ` ~ ~~~ /`7i~c~ris
Firm Name 17 ~~s?t S~~/~~ry'`'" Certified Testa
~2 c7 JJu.b3l~~t iP,., Cert. Testa No. `/~ / >6 gioo D~ /'~ S~sL
Firm Address
Gauge # ~ O J Ul O /
Date last accuracy tested ~ /~ ~ `/ 6
White -Customer's Copy Yellow -City Copy Pink -Tester's Copy