2012_0525 (4)CIIECK ONE.
IRRIGATION DOMESTIC FIRELINE
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: /��S �- /� /� /�� .dam/. r�'�cG' / ��� // i� ��`C,iJ
The baci�Iow prcvmtioa assembly detailed below has bees tested and ma;.,ra;.,ed as required by TNRCC
regulations and is ccrdfied to be operating within acceptable parameters.
TYPE OF ASSEMBLY
e Reduced Pressure Principle � Pressure Vacuttm Breaker
Double Check Valve � Atmosphere Vacuum Breaks
Maaufacna-er Size
Model Number Located At �' -
Serial Number
The above is ce:-tified to be true.
Firm Name /o'sr_,fis ����� /� /� %�� >����'" Certified Testa .
Firm Addrrss %�l� %�` Cent Testa No. � Date - -
Gauge # ' �= �: "�i' 9G
Date Iest a��ur -gay testes
White - Customer's Copy Yellow -City Copy Pink - Testers Copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VACiJUM S�FA�R
Double Check Valve Assembly
1st Check
tad Cheei:
Reiief Valve
Air Islet
Cheek Valve
Initial Test
� -'�- /�
�j7�f
DC- Closed
Tight o
RP- vsid
��� p
Closed Tight a
Leaked o
Opined at
_nsid
Opened at
nsid
Did not Opm o
nsid
Leaked �
Repaus
and
Materials
Used
Test Alta
Repair
DC- Closed
Tight 0
Closed Tight o
Opened at
vsid
Opened at
vsid
vsid
RP sid
The above is ce:-tified to be true.
Firm Name /o'sr_,fis ����� /� /� %�� >����'" Certified Testa .
Firm Addrrss %�l� %�` Cent Testa No. � Date - -
Gauge # ' �= �: "�i' 9G
Date Iest a��ur -gay testes
White - Customer's Copy Yellow -City Copy Pink - Testers Copy