2011_0718CIIECK ONE:
IRRIGATION DOMESTIC
FIRELIN E
BACICFI.OW PREVENTION ASSEA�LY TEST AND MAI2vi'I'ENANCE REPORT
NAME OF PWS_ CITY OF COPPPLL _
PWS I.D. #
LOCATION OF SERVICE: �U � �, . _.r � vv�'.� 1- \ : �- L-
The bacicflow prevention assembly derailed below has bcm tested and maintained as required by TNRCC
regulations and is certified to be operating within acceptable parameters.
TYPE OF ASSEMBLY
c Reduced Pressure Principle C Pressure VacuL�*+ -+ Breaker
[7' Double Check Valve � Atmosphere Vacuum Breaker
Manufacturer '_ � � ° >; ; Size , -'�
Model Number - +;� i I ����` Located At � - '- L �i ;:_ ��s_
Serial Number `- "} ,} L -': I L
The above is certified to be true.
Firm Name � e, � � �.�ow1 f' - f4� �� `���Y"� ` Certified Tester �' �'� r ` ; ' `' `' -
Firm Address �7 U •'�.bx Ct I
Y • ?•C�p��o Cert Teste No. ” � �` " `i �a Date ' / ! r'
;qv �� 'rX � x(1(03
Gauge # � %.��`�! I'�9'L
Date Ia_St accuracy tested �f �' /`
Wtute - Customer's Copy Yellow -City Copy Pink - Tester's Copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VACUUM BRE_AT�'R
Double Cheek Valve Assembly
1st Check
2nd Checl:
Reiief Valve
Air Inlet
Cheek Valve
Initial Test
j /;�� i
DC- Closed
TiehL �
RP- �'- ' - � osid
��� p
Closed Tight c�
Leaked D
... ` �
Opined at
osid
Opined at
osid
Did not Opm o
osid
Leaked �
�P� „'`
and
Materials
Used
Test Af%er
Repair
DC- Closed
Tight �
Closed Tight o
Opined at
nsid
Opined at
osid
osid
RP std
The above is certified to be true.
Firm Name � e, � � �.�ow1 f' - f4� �� `���Y"� ` Certified Tester �' �'� r ` ; ' `' `' -
Firm Address �7 U •'�.bx Ct I
Y • ?•C�p��o Cert Teste No. ” � �` " `i �a Date ' / ! r'
;qv �� 'rX � x(1(03
Gauge # � %.��`�! I'�9'L
Date Ia_St accuracy tested �f �' /`
Wtute - Customer's Copy Yellow -City Copy Pink - Tester's Copy