2012_1012 (3)CIIECH ONE.
IRRIGATION
DOMESTIC
FIRELINE
BACKFZ,OW PREVENTION ASSEIrIBLY TEST AND CE REPORT
NAME OF PWS:
PWS LD_ #
CITY OF COPPELL
LOCATION OF SERVICE: �� /�
The baciflow prevenrioa assembly derailed below has beea tested and maiataiaed as requirzd by TNRCC
regulatio�as aad is certified to be operating withia acc�.cprablc parameters_
TYPE OF ASSEMBLY
C Reduced Pressure Principle c Pressuro Vacutna Breaiaer
�� Double Check Valve o Atmosphere Vacni Breaker
Maaufaeitarr �/� Size 3%�
Model Number Ob 'j/�+ 1 Cl7'j I,.ocated At ��- � � ��
Serial Number �' ����
The above is certified to be true_
Firm Name A �--- �� �-
Firm Address 1�U � °'� 'J �J7 !i ✓�-�!>
Gauge # 0 7 +� 7 ° �� �8
Date last accuracy tested �� � ' - � Z-
Certified Tests �� �" -���" `-"' " 1 `^"�
Cent Testa No. B Pa Z.o 6 /-f� Date /�- / v -lz-
White - Customer's Copy Yellow -City Copy Pink - Tester's Copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VACUUM BRE_��'T:
Double Check Valve Assembly
Relief Valve
Air Inlet
Cheek Valve
1st Checlt /, �
tad Chec3c /. �
Initial Test
DC- Closed
losed Tight
Opined at
Opeaed at
vsid
Tight
Leaked o
nsid
nsid
RP- nsid
j�;ed o
Did not Open o
Leaked o
Repairs
and
Ma�r.+alc
Used
Test ARu
DC- Closed
Closed Tight O
Opeaod at
Opeaod at
tnid
Repair
Tight o
nsid
nsid
RP �d
The above is certified to be true_
Firm Name A �--- �� �-
Firm Address 1�U � °'� 'J �J7 !i ✓�-�!>
Gauge # 0 7 +� 7 ° �� �8
Date last accuracy tested �� � ' - � Z-
Certified Tests �� �" -���" `-"' " 1 `^"�
Cent Testa No. B Pa Z.o 6 /-f� Date /�- / v -lz-
White - Customer's Copy Yellow -City Copy Pink - Tester's Copy