2012_1012 (6)CIIECH ONE: )
IRRIGATION DOt1dES'TIC FIRELINE `----/
BACKFLOW PREVENTION ASSEi��LY TEST AND CE REPORT
NAME OF PWS: CITY OF COPPELL
PWS LD. #
LOCATION OF SERVICE: ��� v ��- `"�•`'P
The bacl-flow prevearioa assembly derailed below has bees tested and maiataiaed as rtquitzd by TNRCC
zzrguiations aad is certified to be operating withia acceptable parameters.
TYPE OF ASSEMBLY
C l Reduced Presstua Priaciplc c Przssurc Vaesnmz Breaker
�f Double Check Valve � Atmosphere Vacu�mm Breaker
Maaufaci�aer G`�`�� Size � �j'
Ivlodei Number � �'a'� f%6�t� Located At � - f� �_�'- ^-� -.�-�� !� Y�
Serial Number `/ -� � �/
The above is cctified to be true.
Firm Name A e�u, -; �.-..t _ Certified Tester �< ----��
Film Address
�0 7j � y. -� h--� wl-�J Cert_ Testa No. �Yo-+- � i�`-� Date / °' -- iz ' Z
Gauge # d 7 � `1 �+��'S'
Date Lest accuracy tested � 3 /' / 2—
White - Customer's Copy Yellow -City Copy Pink - Tester's Copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VACUUM B�FST['F'R
Double Cheek Valve Assembly
Relief Valve
Air Inlet
Check Valve
1st Check 3 ,�
3nd Check Z, g
Initial Test
DC- Closed
Closed Tight ��
Opeaed at
Opeaed at
Tight
Leaked �
nsid
nsid
RP- nsid
u�;� o
Did not Open o
Leaked rJ
�P�
aad
Materials
Used
Test AR,er
Repair
DC- Closed
Tight Q
Closed Tight o
Opeaed at
nsid
Opeaed at
nsid
nsid
RP 'd
The above is cctified to be true.
Firm Name A e�u, -; �.-..t _ Certified Tester �< ----��
Film Address
�0 7j � y. -� h--� wl-�J Cert_ Testa No. �Yo-+- � i�`-� Date / °' -- iz ' Z
Gauge # d 7 � `1 �+��'S'
Date Lest accuracy tested � 3 /' / 2—
White - Customer's Copy Yellow -City Copy Pink - Tester's Copy