HomeMy WebLinkAboutPLIRR2012-0915 t
CITY OF GRAPEVINE
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: GRAPEVINE ANNUAL TEST
IRRIGATION 7�
PWS I.D.# 2200013 OTHER
NAME OF BUSINESS WHERE DEVICE IS LOCATED:
ADDRESS OF SITE SERVICED:
PLUMBING PERMIT IF APPLICABLE: # 1--2-C��Y��f
TESTER LICENSE NUMBER%, EXPIRES:
DATE OF LAST TEST GAUGE CALIBRATION:
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
XDOUBLE CHECK —ATMOSPHERE VACUUM BREAKER
i/
MANUFACTURER: � p
MODEL: ✓O SERIAL NUMBER:
PHYSICAL LOCATION OF METER: �r"
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER
DOUBLE CHECK VALVE
ASSEMBLY AIR INLET CHECK VALVE
1 ST CHECK 2ND CHECK RELIEF VALVE
DC-Closed Tight Closed Tight Open at_psid _psid
Initial RP ;;—psid Opened at
Did not open Leaked
Test _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: c ct �7
ADDRESS:ry�Zr�/7�L�7/ G C}LN CITY/STATE/ZIP: �LL/O /j
DATE: / ° D 7 PHONE NUMBER:
PRINT NAME: (rat10 Q n 114 SIGNATURE:
DOUBLE CHECK VALVE INSPECTION MUST BE CALLED FOR INSPECTION AT(817) 410-3010
C TOCU,E-1ASb@ WLCCALS-9IDmpTXP,.11-ITCEQ 6ACrcR0V.TESTER REGISTRATION dm
11,100/R=..A'116.LdE,".
2461 Wildoak Circle Dallas TX 75228
Telephone:(214)876-1626
oaieCasandovallandscapmg.com
License No.7767 TX -
Statement of Compliance
This irrigation system has been installed at 414 E.Texas St.,Grapevine,TX in accordance
with all applicable State and Local laws,ordinances,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.
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