HomeMy WebLinkAboutPLBG2017-2785 JUL 2 8 2011
CITY OF GRAPEVINE
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: GRAPEVINE ANNUAL TEST
PWS I.D.# 2200013 IRRIGATION
�
] OTHER�—
NAME OF BUSINESS WHERE DEVICE IS LOCATED: AA j M J
ADDRESS OF SITE SERVICED: IGZ7 W'l { a n -T-�U &-c-
PLUMBING PERMIT IF APPLICABLE: # _PL66 17- 2795 q
TESTER LICENSE NUMBER: _ 3PUL>IZ 7Ze� EXPIRES:
DATE OF LAST TEST GAUGE CALIBRATION: - 1
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: SIZE: /1
MODEL: ��� SERIAL NUMBER: T I L�
-7UU 9
PHYSICAL LOCATION OF METER: n X 55 w�(2,4 40
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER
DOUBLE CHECK VALVE
ASSEMBLY AIR INLET CHECK VALVE
1'CHECK 2ND CHECK RELIEF VALVE
Open at_psid _psid
DC losed Tight losed Ti Opened at
Initial P �psid Did not open Leaked
Test n — 7,(7 �11 psid
�� Leaked Leaked
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.
TESTERS FIRM NAME: � Awlcjl(,w '
ADDRESS: P) A'x 2-2,L_ CITY/STATE/ZIP: l'�`I��I ti��ULrl�� 7S0-7
DATE: l -2f-17,� lj PHONE NUMBER:
f
PRINT NAME: "L h di'd;✓A SIGNATURE: ' / �'/
DOUBLE CHECK VALVE INSPECTI+. .
T BE CALLED FOR INSPECTION AT(817) 410-3010
CMp UME-451u 10CWS-11Te Pp PgN111 VCEQ BACKFLOW TESTER RE
11I3IW/Rev.4/5,1 6,vm
JUL, 2 8 2017
CITY OF GRAPEVINE
BACKROW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: GRAPEVINE ANNUAL TEST
PWS I.D.# 2200013 IRRIGATION _
/ OTHER
NAME OF BUSINESS WHERE DEVICE IS LOCATED: �`r'� � ,? 4 Ai ,ma jh ,�zQ"-W
ADDRESS OF SITE SERVICED: {� lb 7-7 l t) i 0-f" '-D , I y C
PLUMBING PERMIT IF APPLICABLE: # 17- 7-795-
TESTER LICENSE NUMBER:__ �W6iZ -1 Zt EXPIRES: J' FS' off
DATE OF LAST TEST GAUGE CALIBRATION; Z4- 0`17
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' r _ATMOSPHERE VACUUM BREAKER
MANUFACTURER: SIZE:
Yv � , 11
MODEL: ( Fb07M ((tJr SERIAL NUMBER: 2 3�
PHYSICAL LOCATION OF METER: S
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER
DOUBLE CHECK VALVE
ASSEMBLY AIR INLET CHECK VALVE
1sT CHECK 2ND CHECK RELIEF VALVE
7 I DG Closed Tight osed Ti Open at_paid _paid
Initial _RP 2, 1 psid Opened at
Did not open Leaked
Test „" i3
Leaked Leaked —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.
TESTERS FIRM NAME: d3a6 L4tVj r
n
ADDRESS: 0 {17c11�� CITY/STATE/ZIP: F714h-e,1 M dU•1c 7S-�Z7
DATE: CS '17�� ��__ PHONE NUMBER:
PRINT NAME: 1, LVa 1-6?Jl it S GIVATURE:
DOUBLE CHECK VALVE INSPECTION Z BE CALLED FOR INSPECTION AT(817) 410-3010
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