2011_0829 (2)CIIECK ONE.
IRRIGATION
DOMESTIC
FIRELINE ,.�
BACI�FI,OW PREVENTION ASSEA�LY 'PEST AND MAIIVTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I_D. #
LOCATION OF SERVICE: /3.i/.yc'V /� u�.- x�/� -s / ?!� / ✓, l�- '.z /fa,c/ 7p arc%
The baci�low prevmtioa assembly detailed below has bem tested and ma;nra;ned as required by TNRCC
rcgulatiotLS and is cer-rified to be operating within acceptable parameters_
TYPE OF ASSEMBLY
C Reduced Pressure Principle C Pressure Vactn�**+ Breaker
�''� Double Check Valve o Atmosphere Vacuum Breaker
Maaufacttaer i��A7T5 Sizc %'�`�
Model Number 00 r/ /n Z Located At ` - '''
: -�,
Serial Number O.SOO� l `
The above is certified to be true.
Firm Name �?• .l „s�,o �•� r�eF r� �F� t� n,J Certified Tester , 1 _ ., --
Firm Address 12o /D �areS�,111 � Cert Tester No. ` ' '' ` - �- � % Date •'-` � f
�All�s ij� 75 2y3
Gauge # '� 1 Q ' Z Z X70
Date last accuracy tested �- �- Zo //
White - Customer's Copy Yellow -City Copy Pink - Tester's Copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VACUUM BRF'A�R
Double Check Valve Assembly
1st Check
2nd Checl:
Relief Valve
Air Inlet
Cheek Valve
Initial Test
DC- Closed
Closed Tight ®"
Opined at
Opined at
vsid
Tight d
Leaked o
vsid
vsid
�
RP- � : '� vsid
,�
I.ealced p
Did not Opm O
Leaked �
�Pa,�
and
Materials
used
Test After
DC- Closed
Closed Tight a
Opined at
Opined at
vsid
Repair
Tight o
vsid
vsid
RP std
The above is certified to be true.
Firm Name �?• .l „s�,o �•� r�eF r� �F� t� n,J Certified Tester , 1 _ ., --
Firm Address 12o /D �areS�,111 � Cert Tester No. ` ' '' ` - �- � % Date •'-` � f
�All�s ij� 75 2y3
Gauge # '� 1 Q ' Z Z X70
Date last accuracy tested �- �- Zo //
White - Customer's Copy Yellow -City Copy Pink - Tester's Copy