2012_1012 (2)CIIECK ONE:
IRRIGATION_` DOMESTIC
�i�if��
BACI�Z.OW PREVENTION ASSEI4IBLY TEST AND CE REPORT
NAME OF PWS: CITY OF COPPELL
PWS LD. #
LOCATION OF SERVICE: / / / � �iSLQ,� -w'z
The bacl-flow preventia�a assembly derailod below has been testod and maintained as required by TNRCC
regulations and is eerdfied to be operating within acecptable parameters_
TYPE OF ASSEI��LY
e Reduced Pressase Priaciplc c Pressure Vaeucmm Breaker
r8� Double Check Valve ❑ Atmosphere Vacuum Breaks
Maaufacntrer �� !3 ��7 Siu Z psi �p
Model 1NUmber �oS .,� Located At Z'� -��t S I oCs- � s��
Serial Number l F- �-w- -1
The above is cati5ed to be true_
Firm Name �i c -c -.- ��-
Firth Address PU � � � � �� ��✓°-%
Gauge # 0 7 � yo t f mod'
Date Iasi accuracy tested `�- � � - � -�
Cereifiod Tester �.1.._ .e� %.> �°"a��`^/
Ceti Testa No..�Po ovb /S'7 Date / J— � z-- /-�
Whit¢ - Customers Copy Yellow -City Copy Pink - Tester's Copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VACLTiJM BiiFe�'w
Double Check Valve Assembly
1st Check 2 , o
tad Chec3c �Z , v
Relief Valve
Air Inlet
Check Valve
Initial Test
DC- Closed
Tight
Closed Tight
r ht�l ❑
Opened at
nsid
Opeacd at
osid
acid
RP- nsid
�;� ❑
Did not Open ❑
Leaked ❑
�P�s
and
Materials
Used
Test After
Repair
DC- Closed
Tight ❑
Closed Tight ❑
Openod at
nsid
Opeaod at
nsid
�d
RP 'd
The above is cati5ed to be true_
Firm Name �i c -c -.- ��-
Firth Address PU � � � � �� ��✓°-%
Gauge # 0 7 � yo t f mod'
Date Iasi accuracy tested `�- � � - � -�
Cereifiod Tester �.1.._ .e� %.> �°"a��`^/
Ceti Testa No..�Po ovb /S'7 Date / J— � z-- /-�
Whit¢ - Customers Copy Yellow -City Copy Pink - Tester's Copy