HomeMy WebLinkAboutCOMA2015-3852 APR 2 8 2016
CITY OF GRAPEVINE
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PAS: GRAPEVINE ANNUAL TEST
IRRIGATION—y—
PWS LDA 2200013 / OTHER
NAME OF BUSINESS WHERE DEVICE IS LOCATED: rV/ �d((� C��a��/i/[Q /Y/9`l
ADDRESS OF SITE SERVICED: 3COD C?VgPQ1IrHe /tti/ f O,�_2.,,M (o/
PLUMBING PERMIT IF APPLICABLE: # I b- 3 �5
TESTER LICENSE NUMBER: (uOn(S to(a'3 EXPIRES: /
DATE OF LAST TEST GAUGE CALIBRATION: I /O- ZO
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 CHECK _ATMOSPHERE VACUUM BREAKER
MANUFACTURER: LA)a45 SIZE: �Z
MODEL: L-FD(gQT SERIAL NUMBER: of 3N ! 7
PHYSICAL LOCATION OF METER: PikAm, S / r 2 /!/(rc {-
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER
DOUBLE CHECK VALVE
ASSEMBLY AIR INLET CHECK VALVE
1sT CHECK 2ND CHECK RELIEF VALVE
_
.DC-Closed Tight losed Tight Open at_paid psid Opened at
Initial _RP JZ psid Did not open Leaked
e t psid
Leaked Leaked
K 1I 14
epair
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.
TESTERS FIRM NAME: 3L7 1ne(Aa0.z1'C'R'/
ADDRESS: tomp CITY/STATE/ZIP: 92,�4 t "f<XRS -7.57-'17
DATE: LI ZI �V PHONE NUMBER: g 7 Z' 23Z- 3�dlo
PRINT NAME: IUa6k 446ti PLe7 SIGNATURE:
DOUBLE CHECK VALVE INSPECTION MUST BE CAL D FOR INSPECTION AT(817) 410-3010
C:IDOCIIME-1lsC 8ILOCALS-1lTempl PgmwiseITCEO BACKFLOW TESTER REGISTRATIONaoc
11IYWIR_.5.1106,ZTE
APR 2 6 2016
CITY OF GRAPEVINE
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: GRAPEVINE ANNUAL TEST
IRRIGATION
PWS1-.D.# 2200013 OTHER FR—
NAME OF BUSINESS WHERE DEVICE IS LOCATED: 'ztxjg / 19112 - GYgOeflµe inil
ADDRESS OF SITE SERVICED: - CQ0 GreltecLff fe 5u,'it (0(3
PLUMBING PERMIT IF APPLICABLE: # - Z
TESTER LICENSE NUMBER: 1 (0l0 3 EXPIRES: I Tiq Z OI 7
DATE OF LAST TEST GAUGE CALIBRATION: if- i0 - Z.O 16
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 CHECK _ATMOSPHERE VACUUM BREAKER
MANUFACTURER: (n AF'r-r5 SIZE: 1I T
MODEL: 55 bCf M 3 C2 'T SERIAL NUMBER: I9 `(V -7
PHYSICAL LOCATION OF METER: k;VC.I-evtt llelc-l- '1'O cooler serves mgzc�;xe u�ofer
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER
DOUBLE CHECK VALVE AIR INLET CHECK VALVE
ASSEMBLY
1sT CHECK 2ND CHECK RELIEF VALVE
C-Closed Tight losed Tight Open at_paid _paid
Initial —RP '7, psid Opened at Did not open Leaked
Tes ''11
t1V
Leaked Leaked �''-,� psid
Repair
Materials
Used
Test DC-Closed Tight Opened at Opened at
After Closed Tight _psid
Repair RP_ psid —paid _psid
The above is certified to be true.
TESTERS FIRM NAME: 31--� MPCcl%�- Cc
ADDRESS: (QCV CITY/STATE/ZIP: K24 WIQvi
DATE: L- 'k? PHONE NUMBER: -I Z-
PRINT NAME: -:S'�O.vt 7. SIGNATURE:
DOUBLE CHECK VALVE INSPECTION MUST BE CA ED FOR INSPECTION AT(817)410-3010
C:IGOCUME-1\Mtte OCALS-11Templ gMWse\TCEO BACKFLMTESTER REGIS WION.do,
11/dWAoV 4105 1 1MG,2110