2011_0829CIIECK ONE.
IRRIGATION
DOMESTIC
�'�
FIRELINE y -'
BACKFZ.OW PREVENTYON ASSEA�LY TEST AND MAINTENANCE REPORT
NAME OF PWS. CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: �% -4N�'y %'�»F��,/�s i�o ,c/ �i����/ Ter �%
The bacicflow prevention assembly detailed below has been tested and maintained as required by TNRCC
regulations and is certified to be operating within acceptable parameters.
TYPE OF ASSEMBLY
C Reduc -d Pressure Principle C Pressure Vag***+ Breake-
�'" Double Check Valve � Atmosphere Vacuum Breaker
Manufactiaer - _ -. Size �" '
Model Number
Serial Number
Located At _�, - ��. r; -
The above is certified to be true.
Firm Name
Firm Address
Gauge #
Date last accuracy tested _ -.
Certified Teste . -
Cent. Tester No. :.> % = - - Date ,'
White - Customer's Copy YeIIow -City Copy Pink - Tester's Copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VACUUM BFL AT�R
Double Check Valve Assembly
1st Checl:
2nd Cheri:
Relief Valve
Air Inlet
Cheek Valve
Initial Test
DC- Closed
Closed Tight C�1
Opened at
Opined at
nsid
Tigizi e'l
Leaked �
nsid
nsid
RP- � nsid
��� p
-
Did not Opea o
Leaked �
Repairs
and
Materials
Used
Test After
DC- Closed
Closed Tight �
Opened at
Opened at
nsid
Repair
Tight 0
nsid
nsid
RP sid
The above is certified to be true.
Firm Name
Firm Address
Gauge #
Date last accuracy tested _ -.
Certified Teste . -
Cent. Tester No. :.> % = - - Date ,'
White - Customer's Copy YeIIow -City Copy Pink - Tester's Copy