2012_0601CIIECK ONE:
IRRIGATION V
DOMESTIC
FIRELIN
BACKFI.OW PREVENTION ASSE1ViBLY TEST AND MAIIV'TENANCE REPORT
NAME OF PWS. CITY OF COPPELL
PWS I.D- #
LOCATION OF SERVICE: ����Zo� �i Z 3 ) 3 ' l l% - g � l -�/ � rt a 1��' - � C1� � n,PT� �� 7 S � • � `j
The bacicflow prcvmtion asscmbiy detailed below has bem tested sad maintained a5 required by TNRCC
rcQUlatiotis and is certified to be operating within acceptable parameters.
C
��
Maaufacnacr
Modci Number
Rtduced Pressasc Principle
Double C/Jheck Valve
�i� � �
��
� � �
Serial Number F� c� ?�Cf "7�
TYPE OF ASSEMBLY
C Pressure Vacutnn Breaker
� Atmosphere Vacuum Breaker
Size
Located At -%� s � 1 /�-f' Si d(1� � 5"� f�
The above is certified to be tnre.
Firm Natne �' At.Y,GI.....i �G�+j ;�G- Certified Tester '�ifi13'(�C -L=S ,R • <� -.�-i t�
Firm Address/}. � `-`X- S t� � Cert Tester No. �'� F v,% � s7 � +f Date o " ! - ( ��
`�C-N ram. Tx "1 b zvL
Gauge # � � 2C 3 ��
Date last accuracy tested % -�-(� ��X z
White - Customer's Copy Yellow -City Copy Pink - Tester's Copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VACUUM BRF °�R
Double Check Valve Assembly
Relief Valve
Air Islet
Check Valve
1st Checl:
2nd Check
Ininal Test
DC- Closed �,
Closed Tight
Opined at
Opened at
osid
t
`�, � �
_
- 1-ighi �
osid �
�-
L,cakcd 0
% `�
osid
nsid
Did not Opm o
Leaked �
�
Repairs
and
Materials
Used
-rat ARer
DC- Closed
Closed Tight o
Opined at
Opined at
osid
Repair
Tight o
osid
osid
gp sid
The above is certified to be tnre.
Firm Natne �' At.Y,GI.....i �G�+j ;�G- Certified Tester '�ifi13'(�C -L=S ,R • <� -.�-i t�
Firm Address/}. � `-`X- S t� � Cert Tester No. �'� F v,% � s7 � +f Date o " ! - ( ��
`�C-N ram. Tx "1 b zvL
Gauge # � � 2C 3 ��
Date last accuracy tested % -�-(� ��X z
White - Customer's Copy Yellow -City Copy Pink - Tester's Copy