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2012_0510 (4)
OIIECK ONE. LR.RIGATION DOMESTIC FIRELINE BACKFi,OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICEt / �� � ��� The bacicflow prevention assembly detailed beiow has been tested and maintained as required by TNRCC rt_eulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY C Rcduccd Pressure Principle c Pressure Varu� Breaker Double Check Valve o Atmosphere Vacuum Breaker Manufacturer Model N>mmber Serial Number Size Located A°t � l (— ► C � The above is ce�rtified�to be trot_ Fsta Name * F1-C' I 1 C7 1�L I� C Firaa Addmss• �- � -�X �c1 1 � �% � �?c. Gsug�e � � C') �I1 Oc-f ► -1 � D Dates Ias�t acet,rscy testes • �! -� 2 - ! Z Catified Testa : 1 ► , \ �-� `�� � L L- / f9'✓k --S Cent_ Testa Nos �a�)CXX�7i� Date - � � �� � white - customer's Copy Yellow -City Copy Pink - Tester's copy REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BR��R Doubie Check Valve Assembly 1st Check 2nd Checl: Relief Valve Air Inlet Cheek Valve Initial Test DC- Closed Tight C7 Closed Tight o Leaked D Opened at asid Opened at vsid vsid RP- vsid �� © Did not Open o Leaked � l2ePair -c and Materials Used Test After Repair DC- Closed Tight O Closed Tight o Opened at vsid Opened at vsid asid RP sid The above is ce�rtified�to be trot_ Fsta Name * F1-C' I 1 C7 1�L I� C Firaa Addmss• �- � -�X �c1 1 � �% � �?c. Gsug�e � � C') �I1 Oc-f ► -1 � D Dates Ias�t acet,rscy testes • �! -� 2 - ! Z Catified Testa : 1 ► , \ �-� `�� � L L- / f9'✓k --S Cent_ Testa Nos �a�)CXX�7i� Date - � � �� � white - customer's Copy Yellow -City Copy Pink - Tester's copy