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MacPlaza1 Sonic-CS 961016
CtIECK ONE: IRRIGATION DOMESTIC FIREIJNE BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT TYPE OF ASSEMBLY , R exiueed Pr~sur~ Principle Double Ch~ck Valve M~I N~b~ ~O~ ~ ~a~ At S~ N~b~ ~ Pressur~ Vacuum Brrakn' Almosph~r~ Vacuum Brealmr REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACIHIM BI~£AKER Double Check Valve Assembly .I 2nd Check ~R~li~t' Valve Air Inlet Check Vnlve Initial T~st DC-Clos~ ~' Clos~d Tiodat O/ Opted at Op~n~d at psid Tight~' L~ked c~ psid psid RP- psid t.~i~i c~ Did not Open m L~ak~l [] and Martials Used , T~st Aft~ DC-Closed Clos~ Tight c2 Opted at Opined at psid R~air Tight [] psid psid RP psid The above is c.~rtified ~o be ~-u~. Gauge # .Z//~/~,~,..9. _/,)/~77-~.q 7~/~/ Date last acc.racy tested ~ -- White - Customer's Copy Yellow - Post-it® Fax Note 7671 Date//- ~.'~pagesii of Co./OepL Co. Phone ~ ~5~ Phone ~ ~ Fax ~ Fax ~ CtlECK ONE: ,,~_~* IRRIGATION DOMESTIC ~// FIREI,INE BACKFLOW PREVENTION A~EMBLY TEgt AND MAINTE~ REPORT N~2v~or?ws: ~ONzEC. ~-r~__ ~ PWS I.D. # LOCAUO SnWC -: ~e b~ P~fi~ ~s~bly ~ bel~ ~ ~ ~ ~d ~m~n~ ~ ~ ~ ~CC Reduc_~_ Pressure Principle Double Check Valve TYPE OF ASSEMBLY Siz~ Locat~l At Pressure Vao-~ Breaker Atmosphere Vacm~m Breaker /// ~ PRESSURE PRINCIPLE ASSEMBLY PRE$$UI~ VA~CUUM 1st ~e~ ~ 2nd ~.e~ R~l~et V~ve ~r I~et ~e~ V~ve ~U~ T~ DC-Clos~ ~Clos~ Ti~t ~ ~ at ~ at psid Ti~ ~ L~ ~ psid p~d ~. psid [~ ~ ~d not ~ ~d Ma~ Us~ T~t ~ DC~i~ Cl~ Ti~t a ~ at ~ at psid ~ Ti~t a psid psid Gauge # Date !~st accuracy tested White - Customer's Copy yollow - City Copy Pink - Tester~ Copy CtlECK ONE: IRRIGATION DOMESTIC FIRELINE BACKFLOW PREVENTION ASSF.~IBLY ~ AND MAINTENANCE REPORT Nmv~ OF PW$: ~ON~.~ ~::r-~ ~ PWS I.D. # LOCATION OF SERVICE: ~'/~ .~' /V~. The ba~flow prcvemion assembly de,,ii~ below h,~ ~ t~st~d and ~i.t,~.~i as required by. TNRCC m.mdafionz and is crnifi~l to b~ Ol~-ati~g w~thi, acceptable TYPE OF ASSEMBLY Manufacturer Model N,--bet S,mal Nembcr P, cduc_~_ Prcssurc Principle r, Double Check Valve m I/ffA~ S~ Located At Pressure Va~--~ Break= Aunosphcre Va~,,m, Br:ak:r !?FDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BR£AKER Double Check V~ve ~s~bly [ 2nd ~e~ ~elj~f VMve ~r I~et ~e~ V~ve Ti~ ~ L~ = , ,paid ' paid ~- paid ~d Ma~ ~= Ti~ o psid psid Date last accuracy tested White - Customer's Copy Yellow - City Copy Pink- Tester's Copy