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Riverside Church-LR010802 (2)
CIIECK ONE: ' IRRIGATION DOMESTIC FIRELINE BACKFLOW PREVENTION ASSEMBLY TEST AND MAIHI~NANCE REPORT NAM~ OF PW$: PWS LD. # LOC^ ONO S WC : The backflow pr~v~ion assembly derailed below bas been ~ and ~.im.i.,,ed as requized by. TNRCC m.~mla:ians and is certified to be operating ii, thin l~.~'jl)~bl¢ p~m~Z~. P,.~iuc~ Pre,ssu~ Princ/ple Double Che~k Valw' Mod~!Number ~)0'7/~ ~ TYPE OF ASSEMBLY Pressure Vacuum Br'~k.-r Atmosph~r~ Vacuum REDUCED PRESSURE PRINCIPLE ASSEMBLY PI~SSURE VACUUM B~R Double Check Va]ye Assembly ~¥. ~e~V 1st Check [ !ad Check alve A~r Inlet ~ alve InitialTest DC-Closed ClosedTi~t 11( Opened~'~ Openedat ~ psid ~'~x~l'~l Tight ;1. RP- psid Test ~ Closed Tight ~ Opened at ~._..~p~M,,, R~air Tight D psid Cert Tester No. /~/~ G ~'/ Da*,' Date last accuracy tested -<~- 01 White - Customer's Copy Yellow - City Copy Pink - Testedas Copy