2012_0911CIIECK ONE-
IRRIGATION
DOMESTIC
FIRELINE
BACICFZOW PREVENTION ASSEA�LY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I_D_ #
LOCATION OF SERVICE: " "i� \/ � '- n \} ��,�. � NT'z`�� - ' � \'Mtkr'Cs`C'� �� �Sirt �
The bacicflow prcvmiion assembly detailed below has bem tested and ma;nta;ned ag required by TNRCC
reeulations and is certified to be operating within acceptable parameters_
TYPE OF ASSEMBLY
C Reduced Pressure Principle C Pressure Vann_***+ Breaker
Double Check Valve C Atmosphere Vacuum Breaker
Maaufacuser �� ���� ` Size �
Model Number � �A � C� - �' � F Located At ��= �- s' __ �� � _ ��: � �M
Serial Nimmber -T1-1 —: � � �'
The above is certified to be true.
Firm Name 3 � 1 •l - 1 - � t � , '� � _ Ceafied Tester i t�
- -
Firm Addrrss 1�'7 � 4 : ", \ Z "- � � , � . Cent_ Tester No. �, s ._ �" . i--'t- Date :,
�'TC' I�A�L�� _GY \ ��C
Ga e # � �'�' ��
� -�- � -'3
Date last accuracy tested 1 � ��.9 � 1
J[.JM BRF'AT�'R
Cherie Valve
vsid
Leaked �
vsid
White - Customer's Copy Yellow -City Copy Pink - Tester's Copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VACI
Double Cherie Valve Assembly
1st Checl:
2nd Cheri:
Relief Valve
Air Inlet
Closed Tight �'
Leaked o
Opened at
vsid
Opined at
osid
Initial Test
DC- Closed
Tight .- � ®'"
RP- vsid
��� p
i
Did not Opm o
ReP a+re
and
Materials
used
Test ARrr
Repair
DC- Closed
Tight [7
Closed Tight o
Opened at
vsid
Opened at
vsid
RP std
The above is certified to be true.
Firm Name 3 � 1 •l - 1 - � t � , '� � _ Ceafied Tester i t�
- -
Firm Addrrss 1�'7 � 4 : ", \ Z "- � � , � . Cent_ Tester No. �, s ._ �" . i--'t- Date :,
�'TC' I�A�L�� _GY \ ��C
Ga e # � �'�' ��
� -�- � -'3
Date last accuracy tested 1 � ��.9 � 1
J[.JM BRF'AT�'R
Cherie Valve
vsid
Leaked �
vsid
White - Customer's Copy Yellow -City Copy Pink - Tester's Copy