2012_1025CIIECK ONE.
IRRIGATION
DOMESTIC
FIRELINE
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D- # �+
LOCATION OF SERVICE: / 17 / � ( 6 � o .y l � ( � 1.
The bacicflow prevention assembly detailed below has been tested and maintained as required by TNRCC
regulations and is certified to be operating within acceptable parameters-
TYPE OF ASSEMBLY
c Reduced pressure Principle C Pressure Vacutmz Breaker
� Double Check Valve o Atmosphere Vacuum Breaker
�i f_ ,�
Manufacturer �- �- Fs "4aS Size
Model Number /� b Located AL '� "�"`�� �-�` --
serial Number �S -� 3 ��
The above is certified to be tzue.
.-- _
Firm Name �. � � L' - �`"� �. � r � /mod � /. Cetifiod Tester � � _ - --
Firm Address 0� fs/ri.c /_- /y�J`�� � ert. Tester No. Date
/Jyr/�._
Gauge # lL�� ����
Date last accuracy tested �% �f -� f
White - Customer's Copy Yellow -City Copy Pink - Tester's Copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VACI.TC7M B�FAT�R
Double Check Valve Assembly
1st Check
tad Cheek
Relief Valve
Air Islet
Cheek Valve
Initial Test
DC- Closed -�
Tight �
RP- vsid
��� p
Closed Tight �'�
Leaked :_ ��' o
� Opened at
nsid
Opeacd at
nsid
Did not Open o
nsid
Leaked �
Repairs
and
Materials
Used
Test After
Repair
DC- Closed
Tight �
Closed Tight o
Opened at
nsid
Opined at
vsid
nsid
RP std
The above is certified to be tzue.
.-- _
Firm Name �. � � L' - �`"� �. � r � /mod � /. Cetifiod Tester � � _ - --
Firm Address 0� fs/ri.c /_- /y�J`�� � ert. Tester No. Date
/Jyr/�._
Gauge # lL�� ����
Date last accuracy tested �% �f -� f
White - Customer's Copy Yellow -City Copy Pink - Tester's Copy