2011_0727CIIECK ONE.
IRRIGATION DOMESTIC
FIRELINE
BACKFLOW PREVENTION ASSE1rIBLY TEST AND MAIN'T'ENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I_D. #
LOCATION OF SERVICE:
The bacicflow prcvmtioa assembly detailed below has bem testLd and maintained as required by TNRCC
regulations and is certified to be operating within acceptable parameters_
TYPE OF ASSEMBLY
Reduced Presstlrc Principle O Pressure Vacuum Breaker
Doubic Check Valve C7 Atmosphere Vacuum Breaker
Maaufactaa-er Size
Model Number � Located At
Serial Number
The above is certified to be true_
Fitm Name - - -.
Film Address
Gauge # -- ; ,
,_. - ,.
Date last accuracy tested
Certified Tester
Cert. Testa No_ Date
White - Custotner•s Copy Yellow -City Copy Pink - Testers Copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VACUUM BRF'�►T�R
Double Check Valve Assembly
1st Check
2nd Cheek
Relief Valve
:fir Inlet
Cheek Valve
Initial Test
DC- Closed
Closed Tight 1&t
Opined at
Opined at
nsid
Ti_sht �i
Leaked o
nsid
nsid
-; :%
RP- �� t)51�
Lcal:ed o
Did not Open o
Leaked 'J
Repairs
and
Materials
Used
Test Auer
DC- Closed
Closed Tight a
Opined at
Opened at
nsid
Repair
Tight o
nsid
nsid
RP sid
The above is certified to be true_
Fitm Name - - -.
Film Address
Gauge # -- ; ,
,_. - ,.
Date last accuracy tested
Certified Tester
Cert. Testa No_ Date
White - Custotner•s Copy Yellow -City Copy Pink - Testers Copy