Denton Tap L2R BA-LR011004CHECK ONE:
IRRIGATION
DOMESTIC
FIRELINE
NAME OF PWS:
PW$ I.D. #
BACK.OW pI~VENTION A~SF.M~LY TEST AND MAINTENANCE REPORT
The bacldlow prevention assembly detailed below has b~en ~ and ,~aintaincd as required by TNKCC
r%~lafion$ and is certified to be operating w~thin acceptable param~.
TYPE OF ASSEMBLY ~ .~
~K ~ , Reduc..'d Presaure P~aciple
= Double Che~k Valve
Manufacturer ]~e.~ ~ e q Size
Modrt Numbs' F O ~, Located At
Pres~are va~ Breaker
Atmosphere Vacuum Bre 'aker
REDUCED pI~E$$UI~ PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI~R
Double Check Valve Assembly
1st Check ~ Relief Valve .Mr Inlet Check Valve
Closed Ti°~t .~ Olma~d at Opened at _._____psid
Imaal T~st DC-CI~s~
Ti~in I,'v Iff Leaked t= ..psid psid
Pa S ~'e~ KP- psid ~ ,~0 Did not Open [~ Leaked
·
T~t~ i 'D~Closed Closed;Tight r~ Opened at Opened at psid
Repair. Tight , ' '~' ' / psid ..____.psid
KP- osid', '
Gauge ii
Date lazt accuracy tested
CHECK ONE:
IRRIGATION
DOMESTIC
BACKFLOW P,~,VENTION ASSF_,M~LY TEST AND MAINTENANCE REPORT
I RECEIVE
PW$ I.D. # D 0~T 1
LOCATION OF, SERVICE:
The bar, lc[Iow prevention assembly detailed below has been tested and m~;-tained as required bv TNRCC
regulaaom and i~ r.~'tffied to be operating witlma acceptable parameters. ' '
Reduc~t Pre~sure Principle
Double Check Valve
Manufacturer ½/el~ $ ~ ~
S alN mb q ll
TYPE OF ASSEMBLY
r~ Pressure Vacuum Breaker
r~ Amaosphere Vacuum Bmak~
Size ~ '/
Locat~i At Gr~ou~d l/~,#lr-
1 REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER
Double Check Valve Azsembly
I 2nd Check R~l;~.f Valve .4~r lnl~t /"h~el~ Valve
Check
iukial T~t DC-Closed Clos~d Ti~t ~ Opened at Opted at .__.___psid
Ti2ht 3,q ~f Leaked ~ psid psid
~~asS¢~l 1~~- ~' psid ~. ~
L~k~d r~ Did not Open c~ Leaked
Mam'ials
Used
T~st Afl. er DC-Closed Closed Tight ~ Opened at Opened at psid
l~air Tight ~ psid psid
RP psid
Date last accuracy tested
White - Customer% r,.-,,, v ,, , .