2012_1012 (5)CHECK ONF-
IRRIGATION DOMESTIC FIRELINB
BAC�'LOR' PREVENTION ASSEMBLY TEST' AND CE REPORT
NAME OF PWS: CITY OF COPPELL
PWS LD. #
LOCATION OF SERVICE: �/ / �
The bacicflow prevention assembly detailed below has bem ttsted and maintained as zequirzd by TNRCC
rcgulatio�ns and is certified to be operating within acceptable parameters.
TYPE OF ASSEMBLY
e Reduced Pressure Principle a Pressure Vaeznma Breaker
�� Double Check Valve D Atmosphez Vacavtn Breaker
Manufactlrrer ���� Size 3f`�
Model Number CJv %'rte t �% Located At � — s �. �-r ��'��
Serial Number �? 88 � `%
The above is oerti5ed to be true.
Firm Name �i c� -- � "'`�
Firm Address nogvSL 7 a'7 - f-c %.�
Gauge # o ? � `� a � a'Y
Date last accuracy testes � 3 / - t 2_-
Certified Tester �•c,•...�. -� ��`��2
Cent Tester No. � ��� G ? T `7 Date / �-- J � /•Y
White - Customer's Copy Yellow -City Copy Peak - Tester's Copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VAGT.TiJM BI2FSSCFR
Double Cheek Valve Assembly
Relief Valve
Air Inlet
Cheek Valve
Ist Check C, �
3ad Check `Z v
Initial Test
DC- Closed
Closed Tight
Opined at
Opined at
nsid �
Tight
Leaked o
nsid
nsid
RP- n_ sid
i � -�t.Y1 �
Did not Opm O
Leaked �
Repairs
and
�ylatwr: ale
Used
Test ASa
DC- Closed
Closed Tight o
Opined at
Opened at
nsid
Repair
Tighe �
nsid
nsid
RP sid
The above is oerti5ed to be true.
Firm Name �i c� -- � "'`�
Firm Address nogvSL 7 a'7 - f-c %.�
Gauge # o ? � `� a � a'Y
Date last accuracy testes � 3 / - t 2_-
Certified Tester �•c,•...�. -� ��`��2
Cent Tester No. � ��� G ? T `7 Date / �-- J � /•Y
White - Customer's Copy Yellow -City Copy Peak - Tester's Copy