HomeMy WebLinkAboutPLIRR2013-1880 'J
CITY OF GRAPEVINE
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: GRAPEVINE ANNUAL TEST
IRRIGATION >k�
PWS I.D.# 2200013 OTHER
SITE DEVICE
ADDRESS OF SERVICED: 2/5 e2[z 4� t ae-S
PLUMBING PERMIT IF APPLICABLE: # \' - `
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TESTER LICENSE NUMBER: /"/ 9 V 9 EXPIRES:
DATE OF LAST TEST GAUGE CALIBRATION: rl Sl. / 7, 12
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
REDUCED PRESSURE PRINCIPLE _PRESSURE VACUUM BREAKER
DOUBLE CIH'ECK/, —ATMOSPHERE VACUUM BREAKER
(At
MANUFACTURER: r IK SIZE:
MODEL: ' 'S C) SERIAL NUMBER:
PHYSICAL LOCATION OF METER: rjT Aouse a 7ri
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER
DOUBLE CHECK VALVE AIR INLET CHECK VALVE
ASSEMBLY
IST CHECK 2"o CHECK RELIEF VALVE
DC-Closed Tight Closed Tight Open at_psid _psid
Initial RP 3= sid Opened at
P 3,2 Did not open Leaked
Test
Leaked I✓ Leaked N/ —psid
Repair
Materials
Used
Test DC-Closed Tight Opened at Opened at
After Closed Tight psid
Repair RP_ psid _psid _psid
The above is certified to be true.
1
TESTERS FIRM NAME:
ADDRESS: 2 0. LRD, ;vZ` CITYISTATEIZIP: 7X 76 5�
DATE: s �'O :/.3 PHONE NUMBER:
PRINT NAME: —de� ��i+�St�+t SIGNATURE:
DOUBLE CHECK VALVE INSPECTION MUST BE CALLED FA INSPECTION AT(817) 410-3010
-
� � - A4UATURF
am
PO Box 625
Grandview,TX 76050
817-866-3082 Office
817-887-3902 Fax
This irrigation system has been installed in accordance with all
applicable State and Local laws, ordinance, rules, regulations
and
orders. I have tested the system and determined that it has been
installed according to the irrigation plan and is properly adjusted
for
the most efficient application of water at this time.
5.3013
OF_rg�1r
...........
GEMY W.DOTSON
......v..
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