2011_0718CIIECK ONE.
IRRIGATION
DOMESTIC FIRELINE � -'
BACKFZOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: �3 U � � ��n �.-�`� F `� �, �
The baci�low prcvmtioa assembly detailed below has bem tested and maintained as requited by TNRCC
regulations and is certified to be operating within acceptable parameters_
TYPE OF ASSEMBLY
C Reduced Pressure Principle c Pressure Vacutmz Breaker
�-� Double Check Valve o Atmosphere Vacuum Breaker
Manufactta-er u � �-, � ` Size � ',
Model Number " �'7 ,� � 1 - � .- Located AL � -. �,_� -. � �_: �� -'._ ) rC., �,
Serial I�iumbcr ` 1' -' `` � `'�
The above is certified to be true.
Firm Name � ,,. ; R'- Certified Tester 11
'� ,
. i I.
Firm Address � ° � �'�,' • c- Cent_ Tester No. � `, r _ , -, _l Date �_
j
%c� .�Z. -mac.. Y. - _T �UC�>
Gauge # � LO `"i 13 `( Z
Date last accuracy tested \�\ \Jl
White - Customer's Copy YeIIow -City Copy Pink - Testers Copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VACUUM BR.E_AKFR
Double Check Valve Assembly
1st Check
Sad Cbeck
Relief Valve
Air Inlet
Cheek Valve
Ininal Test
,
� ,
'
DC- Closed
Tight _
RP- � vsid
Leaked p
Closed Tight
Leaked o
_
Opined at
vsid
Opined at
vsid
Did not Opm a
vsid
Leaked �
Repairs
and
Materials
Used
Test After
Repair
DC- Closed
right o
Closed Ti,Q. ht o
Opined at
asid
Opined at
vsid
vsid
RP sid
The above is certified to be true.
Firm Name � ,,. ; R'- Certified Tester 11
'� ,
. i I.
Firm Address � ° � �'�,' • c- Cent_ Tester No. � `, r _ , -, _l Date �_
j
%c� .�Z. -mac.. Y. - _T �UC�>
Gauge # � LO `"i 13 `( Z
Date last accuracy tested \�\ \Jl
White - Customer's Copy YeIIow -City Copy Pink - Testers Copy