Securelock-LR040528CHECK ONE:
IRRIGATION
DOMESTIC FIRELINK
BACKFLOW PREVENTION ASSEMBLY TES~ AND ~CE REPORT
~ OF PWS:
PWS LD. #
LOCAUONOrSmV~CE: 3~O /~,~, I Z ! , F~O~./f/ ~
The backflow prevention assembly detailed below has been tested and maintained as required by TCEQ
regulations and is certified to be operating within acceptable parameters.
TYPE OF ASSEMBLY
Double C~ck Valve
ID
S~ia~Numbcr 0~.0 ~-/
Prcssu~ Va~m,~ Br~alccr
Ammsphcrc Vv,~,,~ Brcakcr
REDUCED pRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER
Double Check VaJve Assembly
Ist Check J 2nd Check RellefValve Air Inlet Check Valve
Initial T~st DC-Closed Clor,~d Tibia a Op~,t Op~zd ~ psid
Ti~t ID Leaked ~ psid ,. psid
Leaked ~ Did not Open Cl ~ O
Used
T~t ~ DC-Cloud Cloud Tigh~ o Opcncd't Opcmxia~ psid
R~air Tish~ o psid psid ~
P.P psid
Date last accuracy tested
Cerc Tester No. ~Date~
white - Customur~ Copy Yellow - City Copy Pink - TestePs Copy