2012_0730CIIECK ONE -
IRRIGATION_ DOMESTIC
FIRELINE
BACKFi.OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I_D. #
LOCATION OF SERVICE:
nlTowl %tP
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.
C Reduced Pressure Principle
�� Doaub-le /Check Valve
Manufactttrer W /� DTs a
Model Number ��� � D_ TA [� )
Serial Number �N� _. �_ ���
TYPE OF ASSEMBLY
c Pressure Varttt —+**+ Breaker
o Atmosphere Vacuum Breaker
/ �/
Size
Located At �, M {7� R O N D �AJTO.V TAP RD .
The above is cerltified to be trtte.
Fitm Na•*+� Nl� (���iCKi'LOJ�L�.i� � ��le ✓ /�S Certified Tester ����/ � �/"��T
Firm Address �� /AbE -�! /`�"�0. % 42S�S Cent Tester No. � �SS (3 Date �'�O —/ 2--
Gauge � D�slsioo9�5
Date last accuracy tested "� _-� -/ Z
White - Customer's Copy Yellow -City Copy Pink - Tester's Copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VACUUM SlxFatrFR
Double Check Valve Assembly
Relief Valve
Air Inlet
Cheek Valve
1st Checl:
2nd Cheek
Test
DC- Closed
Closed Tight
Opened at
Opined at
vsid
Tight
Leaked O
vsid
vsid
�S
��
RP- / vsid
��� p
� . �--
Did not Opm a
Leaked �
Repairs
and
Mata-ials
Used
Test ARer
DC- Closed
Closed Tight o
Opined aL
Opened at
vsid
Repair
Tight []
vsid
vsid
Rp sid
The above is cerltified to be trtte.
Fitm Na•*+� Nl� (���iCKi'LOJ�L�.i� � ��le ✓ /�S Certified Tester ����/ � �/"��T
Firm Address �� /AbE -�! /`�"�0. % 42S�S Cent Tester No. � �SS (3 Date �'�O —/ 2--
Gauge � D�slsioo9�5
Date last accuracy tested "� _-� -/ Z
White - Customer's Copy Yellow -City Copy Pink - Tester's Copy