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Freeport NIP(7.5)-LR010824
CHECK ONE: IRRIGATION DOMESTIC FIRELINE ~' BACKFLOW PREVENTION A.~EMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: PWS ID. # LOCATION OF SERVICE: The bacl~ow prevention a.ssemb.ly &tailed below has be~ ~ and m~i,,t,i,,ed as required by. TNRCC regulah~ms and is c~-:i~ed to be operating withl, acceptable parameter. = g, zduc~d Pressur~ Principl~ ~ Doubl~ Check Valve a TYPE OF ASSEMBLY Pressure Vacum~ Breaker Atmosphere Vacuum Bresleer REDUCED PRESSURE PRINCIPLE ASSEMBLY I PRESSURE VACUUM BREAKER Double Check Valve Assembly Ist Check [ 2nd Check ye ,.Er Inlet Check l. uirial Tern DC-Clos~ Closed Tight /~ Opened at ~ .Opened at ,/~___~psid ~PP' psid ~- ', Did no~N~pc~ R~air ~ OP~"cda~sid Op~cda~psid .~__~sid Cert. Tester No. ~0~,~ Date White - Customer's Copy Yellow - City Copy Pink - Tester's Copy CHECK ONE: FIRELINE,, IRRIGATION DOMESTIC BACKFLOW PREVENTION A.~F,,M~LY TEST AND MAINTENANCE REPORT NAME OF PW$ I.D. # LOC^~O~' OF S~v~cs: Th~ ba~flow pr~v~ution ass~ubly det~il~ b~low has b~u ~ aud ,~.i.t.;u~d as ~ ~ TN-RCC r~gul~ious R~duced Pm~m'e Primiple DoubW Ch~k V~lve Mo&l Number TYPE OF ASSEMBLY Pressu~ Va~'tnm~ Br~lt~ A~o~ V~ B~ [dd r White - Customer's Copy Yellow - City Copy Pink - Tester~ Coo~ CilECK ONE: IRRIGATION DOMESTIC FIRELINE BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTE~ REPORT NAME OF PWS: PWS I.D. # LOCAnO~' o~ s~v:cE: J~ f~,~/~ The back/low prcve~ioa assgmbl)' cle~ailed below has begI1 ~ alld m~int.l.ed as rcquirgd by. TN'~CC m.~lalious and is c~ified to be o!~rafi~g w~,~i~ ~.~.pr. able param~=s. Double Check Valve TYPE OF ASSEMBLY o Pressure Vacuum Am~osphe~ V~ B~ ModdNumber 6)07k.',- I LocatadAt C~~''-) REDUCED PRESSURE PRINCIPLE ASSEI~BLY PRESSURE VACUU~ BREAKER Double Check Valve[ Ass*mhly ls~ Check I 2nd Check alve .4~r InJet · Initial Test DC-Closed Closed Tight ~ Opted a~N. Opened at ./ ~_~_._psid Tigt~3 6 ~ Leakcd~.7__ a psid~, ~_ps I~P- "' vsid Us~ ! T~st .Mg~ ~-Closed k/ Opted at psid R~air Tight ~ ' psid psid RP p$id Tbe above is certited to be true. Certified Te~l~r ~_l'e_~c- C~t T~r No. ~ ~' ~ Wh/te - Customer's Copy Yellow - City Copy Pink - Tester's Co~l/ CHECK ONE: DOMESTIC FIRELINE X IRRIGATION BACKFLOW PREVENTION ASS~IBLY ~ AND MAINTENANCE REPORT NAME OF PWS: PWS I.D. # Th~ bac. lfflow pr~v~fio~ ass~mb~' der, xil~d below has be~ ~ md -,,i~,,~-ecl as ~ by TNRCC r~p~!sviolls ~ is e..~'tifi~l to be op~-al;mg within acceptable pa~ ~.~eters. R~uced Prcssurc Prmcip. 1¢ Doubk Check Valve r~ Ig,O.'rr5' s~ S~rial Number TYPE OF ASSEMBLY Pr~sur~ Vacumn Br~k~- Aunospher~ Vacuum Br~k~ REDUCED PRESSURE PRINCIPLE A~SEMBLY I PRESSURE VAC"IKJM BREAK]gR Double Check Vnlve[ Azs~mhly ~ef~ v ~ve Ist Check f 2nd Check · Air Inlet Ch Ini6al Test DC-Closed Clo,~ T,i~hl ,~ Opened at "~,.Opmed a£ ~.___.psid · ~id ~ Tigh~ 3. t' ~ Leaked ~. ~ ~ psid I sid RP- psid - Ma ' RP p, id c~i~i T~,= ~'~ Cen. Tcs~rNo. V~~/ Da~ 7 Date last accuracy tested ~;- J~fO [ White - Customer's Copy Yellow - City Copy Pink - Testers Copy CllECK ONE.' IRRIGATION DOMESTIC FLRELINE BACKFLOW PREVENTION ASSEMBLY TEST AND ~ it. NANCE REPORT NAME OF PWS: PWS I.D. # LOCATION OF SERVICE: The baa~low pr~ntion assembly d~ailed below ha~ been tested ~ud ~,i~ni~ed as re4uir~ by. TNKCC r%m~la~ions a~i is c~dti~d ~o be op~raling with~ acceptable paramours. TYPE OF ASSEMBLY Double Check Valve Med~l Number ~ S~iaiNumber ~i'~ ~ REDUCED PRESSUR~ PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER Doublelst Ch~l~Check Vsive[, Asr~mhly ~e 'air· -- ~V~v ,2nd Check .Mr Inlet · Closed Tight 1~ Op~n~at~ Opened at / psid Iniu~l Test DC-Clos~ R~-_=___psza ~.~' TD'C~°~//~ ~ ~id Ol~n~:l~ x.. p,id ~j~ ~,~id~ p,id C~ifi~d T~,~r Cat Testa' No. Date last accuracy tested ~o~{-'~ / White - Customer's Copy Yellow - City Copy Pink - Tester~ Copy CtlECK ONE: IRRIGATION DOMESTIC FIRELINE ~ BACKFLOW PREVENTION A.~EM~LY ~ AND MAINTENANCE REPORT NAlv~ OF PWS: PWS I.D. # LOCATION OF $ffRV]C£: 3q 0 F,"c-~do,'-l' £1et..., ~.. Th~ back,ow prevention assembb' derailed below h~ ~ ~ and ,.~.i.r.i.ed as reqtm'ed ~ TN~CC r~m:ions and is cer~ied tn be operm~ng v~th~ accew, ble parmnet~'~. TYPE OF ASSEMBLY R~duc-~_ Pre~m~'~ Prin~le ~ Double Check Valve I2 Pre~m~re Vacuum Bn~k~r A~nosphere Vacuum Break~ Manufacturer ~'1/~'~ Siz~ ModelNumber 607~, ~ LocataxiAt g,u.~W- ,4,;- ~' Scri~flNumber /"/~3 ~' REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM B~R Double Check Valve A.ss,~hly l~ Check [ 2.d Checkl~ller V~ .~ir l-~et C~V~Ive Initial T~st DC-Closed Closed Tight ~(. Opened at ~ ~.Opcned at / / osid ~Ti'~b~Z'HKP' psid ~'C L'..ak~,{ ~D ~sid s~ Leaked o =ed at I~r psid ~sid RP psid C~,. Tezta' No. /~/, l) ~"// n Date last accuracy tested White - Customer's Copy Yellow - City Copy Pink - Testers Copy