2012_0910CIIECK ONE-
IRRIGATION
DOMESTIC
FIRELINE �
BACKFLOW PREVEN'T'ION ASSEA�LY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: '" � T�/ ,C= , �c`� \� 1;;> LL_ �'��{c L r SIT -Y
The baci�low prcvmtioa assembly detailed below has bem tested and maintained as required by TNRCC
rceulatiotLS and is certified to be operating within acceptable parameters_
TYPE OF ASSEMBLY
e Reduced Pressure Principle C Pressure Vacutmm Breaker
Doubic Check Valve o Atmosphere Vacuum Breaker
Manufacturer \ � ��_ Size � . p
Model Number -� � � � � X �., � - � Located At � t � -
r
Serial Number �� � i i' �-
The above is cec'ufied to be rave_
Film Natne
_- ,— ,� , Certified Tester
Firm Address ` ', - Cert Tester No. � �� ,Date ��
s.
Gauge # :i ., t i`
Date last accuracy tested '� _ a
��_
White - Customer's Copy Yellow -City Copy Pink - Tester's Copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VACUUM B�FS�R
Double Check Valve Assembly
Relief Valve
Air Inlet
Check Valve
1st Check
tad Checl:
Initial Test
DGCloscd
Tight _._ A ®'
RP- : - nsid
Leaked p
.Closed Tight �`
Leaked �
.,g
Opined at
nsid
Opened at
nsid
Did not Opm o
nsid
Leaked �
�P��
and
Materials
Used
Test ARer
Repair
DC- Closed
Tight a
Rp aid
Closed Tight o
Opened at
nsid
Opined at
nsid
nsid
The above is cec'ufied to be rave_
Film Natne
_- ,— ,� , Certified Tester
Firm Address ` ', - Cert Tester No. � �� ,Date ��
s.
Gauge # :i ., t i`
Date last accuracy tested '� _ a
��_
White - Customer's Copy Yellow -City Copy Pink - Tester's Copy