HomeMy WebLinkAboutPLIRR2017-2293 CITY OF GRAPEVINE
BACKROW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: GRAPEVINE ANNUAL TEST
IRRIGATION G�-
PWS LDN 2200013 OTHER
NAME OF BUSINESS WHERE DEVICE IS LOCCAATED:` i� ,A-7Cc
ADDRESS OF SITE SERVICED:
PLUMBING PERMIT IF APPLICABLE: #
TESTER LICENSE NUMBER: EXPIRES:
DATE OF LAST TEST GAUGE CALIBRATION: /'Z/Z -/2
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: L/1 /_�S SIZE:
MODEL: Z�;'15 SERIAL NUMBER:
PHYSICAL LOCATION OF METER: oY�
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER
Z�4 DOUBLE CHECK VALVE AIR INLET CHECK VALVE
ASSEMBLY
Ip4pj IT CHECK 2"o CHECK RELIEF VALVE
Open It_psid _psid
DC-� se Opened at
Initial RP _psid Did not open Leaked
Test -ez _psid
Leaked Leaked
Repair
Materials
Usod
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: BackflowPreventer Testing&
Repair ery ce
ADDRESS: CITY/STATE/ZIP: 2616 Handley Dr.
DATE: PHONE NUMBER: 817-705-0237
PRINT NAME:/, iZEi/ G SIGNATURE:
DOUBLE CHECK VALVE INSPECTION MUST BE CALLED FOR INSPECTION AT(817