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2011_1207CIIECK ONE: IRRIGATION DOMESTIC FIRELINE BACKFI,OW PREVENTION ASSEMBLY TEST AND MA.INI'ENANCE REPORT NAME OF PWS: CITY OF COPPELL _ PWS I.D. # J �� - � LOCATION OF SERVICE: i ` / '� The bacl� -flow prcvmtion assetnbly detailed below has bem tested and maint�ed as required by TNRCC regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY e Reduced Pressure Principle C Pressure Va�-cn —�**+ Breaker � -�" Double Check Valve � Atmosphere Vacuum Breaker Maaufactazrer Size � /r/ Model Number - Located At ,_'�'I c'` �I l'i' L- Serial Ntmber l i -- - -- I - - f' The above is certified to be true. � ,. Firm Name � � � �_ � : ; �) t`� _ ' Cetified Tester - - "T U ! L- �_� t _� � CerL Tester No:. - � ' ? Dau - -- Firm Address -� ;•,-� -_ ,.; � -/ �� Gauge # � i_ � �_ llate last accuracy tested (�_��l- L � `J White — Customer's Copy Yellow —City Copy Pink — Tester's Copy REDUCED PRESSURE PRINCIPLE ASSEA�LY PRESSURE VACUUM B><t��R Double Check Valve Assembly 1st Check 2nd Chccl: Rc[ief Valve Air Inlet Chec3c Valve Initial Test DC- Closed Closed Tight _, -�' "Opined at Opined at nsid Tight. -� -- � Leaked o nsid nsid RP- ` -- ° nsid u�;cd � o -- �, Did noc Opm o Leaked J Rcpatrs aad Materials Used Test ARer DC- Closed Closed Tight a Opined at Opined at nsid Repair Tight � nsid nsid RP sid The above is certified to be true. � ,. Firm Name � � � �_ � : ; �) t`� _ ' Cetified Tester - - "T U ! L- �_� t _� � CerL Tester No:. - � ' ? Dau - -- Firm Address -� ;•,-� -_ ,.; � -/ �� Gauge # � i_ � �_ llate last accuracy tested (�_��l- L � `J White — Customer's Copy Yellow —City Copy Pink — Tester's Copy