2012_1012 (4)CIIECK ONE: /
IRRIGATION DOMESTIC FIRELINE `✓
BACi�LOR' PREVENTION ASSEMBLY TEST AND CE REPORT
NAME OF PWS:
CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: ��/ V
The baci-IIow prevention assembly detailed below has been tested and maintained as required by TNRCC
regulatiarss and is certified to be operating within acceptable paramettcs.
C Reduced Pressure Principle O Pressure Vag- +n+*++ Breaker
�� Double'' C //heck Valve o Atm�%osphere Vacuum Breaker
Maaufacttaer
!N Size ° ��
Model Number � � t7 t�eiA/'Q� Located At �� f % � . �-� � �'�`°�'
Serial Number // �'� J ��
The above is certified to be true.
Firm Name �i cam- X6--2 , -
Firm Address P � i3 v � � 9 � ���
GBUge # O ? � 9j' 4-.N�
Date last accuracy tested 7- 3 i - 1 .y
Certified Tester ,�. -�-�� C �
Cart Testa No. g povy f fS' � Dace / �' - /z -� �-
White - Customer's Copy Yellow -City Copy Pink - TPSter's Copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSiJRE VACIJL7M BRE_�►�'R
Double Check Valve Assembly
1st Cheek ?�
tad Checir Z•
Relief Valve
Air Inlet
Cheek Valve
Initial Test
DC- Closed
losed Tight
Opined at
Opened at
acid
Tight
Leased �
nsid
nsid
RP- nsid
t r.�t -.� �
Did not Opea O
Leased �
Repairs
and
lyjatrr:alc
Used
Test Alta
DC- Closed
Closed Tight o
Opeaod at
Opened at
nsid
Repair
Tight a
nsid
nsid
RP sid
The above is certified to be true.
Firm Name �i cam- X6--2 , -
Firm Address P � i3 v � � 9 � ���
GBUge # O ? � 9j' 4-.N�
Date last accuracy tested 7- 3 i - 1 .y
Certified Tester ,�. -�-�� C �
Cart Testa No. g povy f fS' � Dace / �' - /z -� �-
White - Customer's Copy Yellow -City Copy Pink - TPSter's Copy