2012_0525 (2)CIIECK ONE.
IRRIGATION
DOMESTIC
FIREI.INE V
BACKFT.OW PREVEN'T'ION ASSEMBLY TEST AND M.4II�TI'ENANCE REPORT
I.I`u1�a1��• :L�7
PWS I.D. #
CITY OF COPPELL
LOCATION OF SERVICE: I5� {3AP'�'i_s�i �hc.� R ch o-f CnuflE l) /.S 90 S p�to� T D Ryl
The bacicilow prevention assembly detailed below has bees tasted and maintained as required by TNRCC
regulations and is certified to be operating within acceptable parameters.
C Reduced Pressure Principle
"�
Double Check Valve
Maaufacnaer
� � b C t?
Model Number
�' S � nC D A
Serial Number
� � �3 i 1 1 7 1 l.s � C„
TYPE OF ASSEMBLY
C Pressure Vann***+ Breaker
o Atmosphere Vacuum Breaker
Size � --
Located At F+ 2 E p. �- by �rC'1 v t wA V S i"!2� ��'
T
The above is certified to be trot. t of 7 � � 'J]`'� $ - � 7 'J '�
Firm Name ?��"� P ?�� -f�� c Spr2) � � tk'��T � X' Ceiti£ed Tests _ /%icl�� t / � %�iE'/ � t
Firm Address `�C., f_3�x � `�;3 � `1 1 Cert. Testis No. b�/ -�y/ ° ii � G- Date S 5 �
Gauge # _ �� pr;��, =,
Date Iast accuracy tested Jr �� J �
White - Customer's Copy Yellow -City Copy Pink - Testers Copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VACUUM BRF'A�'R
Double Check Valve Assembly
1st Check
tad Check
Relief Valve
Air Inlet
Cheek Valve
Initial Test
DC- Closed
Closed Tight ,�
Opened at
Opined at
vsid
S j
Tight ¢l
Rp_ '7. h psid
Leaked C7
Leaked o
� - (�
vsid
vsid
Did not Opm O
Leaked �
I�Pa „t
and
Materials
Used
Test Altar
DC- Closed
Closed Tight o
Opened at
Opined at
vsid
Repair
Tight o
vsid
vsid
RP sid
The above is certified to be trot. t of 7 � � 'J]`'� $ - � 7 'J '�
Firm Name ?��"� P ?�� -f�� c Spr2) � � tk'��T � X' Ceiti£ed Tests _ /%icl�� t / � %�iE'/ � t
Firm Address `�C., f_3�x � `�;3 � `1 1 Cert. Testis No. b�/ -�y/ ° ii � G- Date S 5 �
Gauge # _ �� pr;��, =,
Date Iast accuracy tested Jr �� J �
White - Customer's Copy Yellow -City Copy Pink - Testers Copy