HomeMy WebLinkAbout26-000171 - Backflow Report..._ F6'}a.A- .. mot be,:,na for each assembb, Eesle& A si•:,nci d dated uxiuii*Jbe submilted to the iubbewwersu,, .=e, iL ,
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e ow _ prevention assembly detailed below has been tested and maintained as required y commission l `o s
and is certified to be operating wiLbin aWairubleparameters.
TYPE OF BACIUWW
.. I care `tact l _.. ..�.._,..�'
Reduced
c es Principle -Detector _ ) _Typ fl,n'
iDouble Chbck Valve (DCV - _._....
PressureVacua Breaker Spill-ResistantVacuum , Breaker (V )
Mamufactuxer. fMain: Main: Bypass:
---
Serial r: • ' Bypass;. Location.
Model r: ; gxe. PA - . ... Se
gi ,
PERM
T NUMBER:
o fort 10, .. xi m.,mi.��Iza jIs the L.
assembly ......,... �.._._ _,...tons 1 c ?
y to accordance a n y s .
Is e assembly non -potable i supply ).
_ .._ ...: _. .__ 1 o
. ,.._ µ W... _...._ _.M.. • . ........
TEST MULT Type 11
Reduced Pressure •lAssembly
I VA
Relief Valve Bypass Check AirWet Check ValveFAIL 0 1,9 Check 2ud Check***
o-'
,,',rnjtifa Tea
Held
at psid, eat reidOpened at _Held at �` d ......, sid e
Held
sad d Tight �' t not open
a
Time: Did not
Leaked 0
sDid it fully o Leaked ;
open
_ (Yea 1111
Repairs and Waim'
Wataials
Used" Bypass:
Test el at — -� p, i elt ld st } en p Held at
,
After:Held at rd sld n a.w !
e .r ClosedTight 4 Tight P id
Time: 1 t
c k: numeric r•ink're' epressure,we as �� ., for Potable:�...on �..,,,.
Differential .. ..�... ort-. .... µ �.:.:....
*
tl:
Makefflddel:
• ate tested r c c :°
a .
%
e
-Company Name:Licensed Tester e
( ye rye)
CompanyAddress: Licensed Tester -Name (Si ):
Co one : BPAT Lice
License Exilrution Date:
vie certified to be true at the time
TEST RECORDS MUST BE KEPT FOR AT LEAST [30 TAC §29M46(8)]
** USE ONLY REPLACEMENT PARTS
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