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Valley R Baptist 2-LR030320Apr 23 03 10:17a CIIECK ONE: ROGERS OHRIEN 8174919461 IRRIGATION DOMESTIC IC FIRELINfi _ BACKFLO W PREVENTION ASSF; IVIBLY TEST AND MAINTENANCE REPORT NAME OF PWS: / CtppI 1 PWS I.D. # p.2 LOCATION OF SERVICE: RA�}G�, „ {3A�j ,, S _I, , 2cL, — l✓J r - ��►� Rd . The back flow prevention assembly detailed belol r has been tested and maintain as requited by TNRCC regulations and is certified to be operating within acc:ptable parameters. TYPE ;)F ASSEMBLY ❑ / Reduced Pmsttre Principle ❑ Pressure Vacuum Breaker Y Double Check Valve ❑ Atmosphere Vacuum Breaker Manufacturer t wm:" 2 Su 9 Model Number La, aced At 113 \)A(2 FL tJ( aN Serial Number The above is certified to be true. • .I!IZ r L ..a _ Gauge # g6(agq'd _. FRIFH. �,,. CaL ' fester No 2 3759 Lam Date 3 o 723 Date last accuracy tested White - Customer's Copy Yellow - City Copy Pink - Tester's Copy REDUCED PRESSURE PRINCIPL,I's ASSEMBLY PRESSURE VACUUM BREAKER Double Check Valve Assembly 1st Check 2nd Cheek Relief Valve Air Inlet Cheek Valve Initial Test DC- Closed sod Tight 7'f Opened at Opened at n sid Tight Leaked ❑ n sid n sid RP - Leaked C3 Did not Open ❑ Leaked C3 iep� and Materials Used Test After DC- Closed Closed Tight ❑ Opened at Opened at n Sid Repair Tight ❑ o Sid n Sid RP sid The above is certified to be true. • .I!IZ r L ..a _ Gauge # g6(agq'd _. FRIFH. �,,. CaL ' fester No 2 3759 Lam Date 3 o 723 Date last accuracy tested White - Customer's Copy Yellow - City Copy Pink - Tester's Copy Apr 23 03 10:18a CHECK ONE: ROGERS OBRIEN 8174919461 IRRIGATION DOMESTIC FIRELINE BACKFLOW PREVENTION ASSEMI: SLY TEST AND MAIIVTENANCE REPORT NAME OF PWS: PWS I.D. # p.3 LOCATION OF SERVICE: RR "k 4 ' E k' :19 2 c l - L4,51 R h r R I The back-flow prevention assembly detailed below has been tested and maintained as required by TNRCC regulations and is cctified to be operating within accept. ble parameters. TYPE OF ASSEMBLY ❑ uteri Pressure Principle ❑ Pressure Vacuum Breaker Double Check Valve ❑ Atmosphere Vacuum Breaker Manufacnser U Ali [, Size Model Number _ OD'j_Lyl I Located At 'T't l Jpu ri AT i tzw.t Serial Number .46 ti.�g REDUCED PRESSURE PRINCIPLE A SSEMBLY I PRESSURE VACUUM BREAKER Double Check Valve Assembly 1st Cheek 2nd Check- R.:Gef Valve Air Inlet Check Valve Initial Tat L osed losed Tight O Zed at Opened at n sid Leaked ❑ _,, n sid n sid ❑ Did not Open ❑ Leaked ❑ Repairs and Materials Used Test After I DC - Closed I Closed Tight ❑ Op :red at Opened at n sid Repair Tight ❑ _,• n sid RP e sid The above is certified to be true. Firm Name &i.kF6„9 Certified7ester Firm Address 4 A;Q Z%W A Cat. Test. x N OAII LL. Date t 53 Gauge # d 617 l Date last accuracy tested -A L/11 White - Customer's Coov Yellow - Ci 1}0 11,,.,, Apr 23 03 10:18a ROGERS OBRIEN 8174919401 CIIECK ONE: IRRIGATION DOMESTI : ; FIRELINE BACKFLOW PREVENTION ASSEM:liLY TEST AND MAINTENANCE REPORT NAME OF PWS: PWS I.D. # p.4 LOCATION OF SERVICE: \//,I It?J The bacldlow prevention assembly detailed below as been tested and matutam regulations and is certified to be operating within accept s ble parameters. m�tr by TNRCC 0 Reduced Pressure Principle 41/ Daubie Check Valve TYPE OF: ASSEMBLY ❑ Pressure Vacuum Breaker ❑ Atmosphere Vacuum Breaker Size u Locate d At 9l M JT�Lf= R RED PRES SURE PRINCIPLE I SE MBLY Double Check Valve Assembly 1st Check 1 2nd Check Initial Test Dc closed Tight G RP - nn.A4 Leaked 0 and Materials Used Test After I DC - Closed Repair Tight Did not Open o I Leaked Closed Tight ❑ Ol:,med at � Opened at o sid _.. o sid certified The above is FirmName A-1 FirmA dc l ress - LW 4 / Cert. Tesi err N 0032 Due 0 - 03 Gauge #k �( Date last accuracy tested PRESSURE VACUUM BREAKER Inlet Tight C:lxaed at Opened at o sid C _.. p sid o sid C White - Customer`s Coov volt..,.. - 04- r