2012_0612CIIECK ONE.
IRRIGATION DOMESTIC FIRELINE
BACKFI,OW PREVENTION ASSEMBLY TEST AND MAIIVT'ENANCE REPORT
NAME OF PWS. CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: -7-=� \ � �' �� e \��r\
The bacicflow prevention assembly detailed below has been testad and :„a ;" *a ;r,ed as required by TNRCC
rzQUiations and is certified to be operating within acceptable parameters.
TYPE OF ASSEMBLY
c Rtduced Pressrzrc Principle C Pressure Vacurnn Breaker
�'* Double Check Valve O Atmosphere Vacuum Breaker
Manufacttser � = Size '
Modci Number ' Located At - �' ''
Serial Number r
The above is certified to be true.
Firm Name � '� s , . P � �• - t ,�or>`t1 a{`� Certified Testa ,, ;, .
Firm Address _ ` Cezt Tester No. %�% ` i Date
` + P a ��-. �� 1� 1�
Gauge # 'x'7,1 ";�� r� fo L'i
Date last accuracy tested 7�T_
White - Customer's Copy Yellow -City Copy Pink - Tester's Copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VACUUM BRFA_�R
Double Check Valve Assembly
1st Chek:
2nd Cheri:
Re3ief Valve
Air Inlet
Check Valve
Initial Test
DC- Closed
Tight of
Closed Tight �
Leaked �
Opened at
nsid
Opined at
nsid
nsid
Rp- nsid
I.,eaied p
Did not Opm o
Leaked �
Repairs
and
Materials
Used
Test Aria
Repair
DC- Closed
Tight o
Closed Tight o
Opened at
nsid
Opined at
nsid
nsid
RP sid
The above is certified to be true.
Firm Name � '� s , . P � �• - t ,�or>`t1 a{`� Certified Testa ,, ;, .
Firm Address _ ` Cezt Tester No. %�% ` i Date
` + P a ��-. �� 1� 1�
Gauge # 'x'7,1 ";�� r� fo L'i
Date last accuracy tested 7�T_
White - Customer's Copy Yellow -City Copy Pink - Tester's Copy