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HomeMy WebLinkAboutPLGUA2018-1171 I CITY OF GRAPEVINE BACKELOW PREVENTION ASS9MBLY TEST AND MAINTENANCE REPORT NAME OF PWS: GRAPEVINE ANNUAL TEST tRRIGATION PINS I.D:# 22090'13 OTHER NAME OF BUSINESS WHERE DEVICE IS LOCATED: n ADDRESS OF SITE SERVICED: C% q T� LUMBING PERMIT IF APPLICABLE; 0 TESTER LICENSE NUMBER: hchmL'Tt, 1 _ EXPIRES: 4 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 PARAMMRS. TYPE OF ASSEMBLY REDUCED PRESSURE PRINCIPLE PRESSURE VACUUM BREAKER DOUBLE CHECK _ATMOSPHERE VACUUM BREAKER MANUFACTURER; U A : - .�SIZE: MOlDFL: L k i3 PHYSICAL LOCATION OF METER: '' 421-,—A : REDUCED PRMUR€PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER DOUBLE CHEC1t VALVE ASSEMBLY AIR INLET CHECK VALVE im CHECK 2'CHECK RELIEF VALVE I7�-CloeadTighl Opanat`gild pyld Init[ai P O rto _ _pgld r/ po d a4 Taat Dkd net aoan LAIA"d Looked Leaked Paid 'MataraYka Ufa6 Tact QC Ckr ed Tl k( OPenid at ppanad a( After Clesod Tiph( Rapair RP— paid —paid peld Paid Th a+bava Is Caaffled[o bo true TESTERS FIRM NAME: -I AIsDFEESBS � *eft°__ ••,�L CRYrSTAT mp.. 1 CIS DATE: �.t,' � PHONE NUMBER_ PR$N' 110141E - I SIGNATURE: DOUBLE CHECK VALVE INSPECnON MUST BE CALLED IuSzECrlCfiR y© f