2012_1012CIIECH ONE.
IRRIGATION DOMESTIC °/ FIRELINE
BACi�ZOW PREVENTION ASSEMBLY TEST AND CE REPORT
NAME OF PWS: CITY OF COPPELL
PWS LD. #
J
LOCATION OF SERVICE: / //d
The bacl-flow ptaveation A4G�}'ly detailed below has been rated and maintained as tzquited by TNRCC
regulations and is certified to be operating within acceptable parameters_
TYPE OF ASSEI��LY
C / Rtduced Presstu�e Principle c Presssat Vacsnna Brealaer
� Double Check Valve � Atmosphere Vacuum Breaker
Manufacttaer Gc��/ Size � /�
Model Numba O z' �% Located At _! Sr �' � ��
Serial Number h- �.ss- "-�� ��
The above is certified to be trtsc.
Firm Name � G -�--•� �L--- Certified Tester ��e� �_o -ate-✓
Firm Address F� °Bc�� %�1T GJ�� -,G Cent_TestQNo. $�v�l��S7 Dau /a -�z -�v
Gauge # p r/v y- v�j-��
Date last accuracy tested .7 � I - � 'Z
Whit¢ - Customer's Copy Yellow -City Copy Pink - Tester's Copy
REDUCED PRESSURE PRINCIPLE ASSEIrIBLY
PRESSURE VAGTJUM BREAKER
Double Check Valve Assembly
Rdief Valve
Air Inlet
Check Valve
1st Cheek / . 8
tad Cbeck I �
Initial Test
DC- Closed
Closed Tight
Opened at
Opened at
nsid
Tight
Leaked o
nsid
nsid
RP- nsid
L,�y;ed p
Did not Open o
Locked o
Repairs
and
Materials
Used
Test After
DC- Closed
Closed Tight o
Opeaod at
Opined at
_paid
Repair
Tight �
nsid
nsid
RP sid
The above is certified to be trtsc.
Firm Name � G -�--•� �L--- Certified Tester ��e� �_o -ate-✓
Firm Address F� °Bc�� %�1T GJ�� -,G Cent_TestQNo. $�v�l��S7 Dau /a -�z -�v
Gauge # p r/v y- v�j-��
Date last accuracy tested .7 � I - � 'Z
Whit¢ - Customer's Copy Yellow -City Copy Pink - Tester's Copy