2012_1012CIIECK ONE.
IRRIGATION
DOMESTIC L/
FIRELINE
BACiCFZOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: %//
The bacicflow prevention assembly detailed below has been tested and mainrained as required by TNRCC
regulations and is certified to be operating within acceptable parameters.
TYPE OF ASSEMBLY
�C-/ Rcduced Pressure Principle C Pressure Van1L**n Breaker
l� Doublc Check Valve � Atmosphere Vacuum Breaker
Manufacturer 1 -y�-' Sizc -�
Model lv amber �D 7 m � z�
Scrial Number Z t 9 �
Located At �� � �� �St,�f-
The above is certified to be true. � /�
Firm Name .� C� -�• ��— Certified Tester /�e.r+ni�lt. C..%o'�I�.z -�
Firm Address P ° B v � � 9 -7 Gc�;��� Cert. Tester No. 13 P� � �' � / Sr'/ Date / °- / z- i
Gauge # � %�7a��d� !y
Date Iast accuracy tested `7 3 l - 1 z
White - Customer's Copy Yellow -City Copy Pink - Tester's Copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VACI.TCJM BR_.r�F�R
Double Check Valve Assembly
Relief Valve
Air Inlet
Cheek Valve
1st Cheek %. �
2nd Checl: J . 8
Initial Test
DC- Closcd
Closed Tight
Opined at
Opined at
nsid
Tight t.e'
Leaked D
nsid
nsid
RP- vsid
Lcaked D
Did not Open D
Leaked �
Rcpatrs
and
Materials
Used
Test After
DC- Closed
Closed Tight o
Opined at
Opined at
nsid
Repair
Tight t7
nsid
nsid
RP sid
The above is certified to be true. � /�
Firm Name .� C� -�• ��— Certified Tester /�e.r+ni�lt. C..%o'�I�.z -�
Firm Address P ° B v � � 9 -7 Gc�;��� Cert. Tester No. 13 P� � �' � / Sr'/ Date / °- / z- i
Gauge # � %�7a��d� !y
Date Iast accuracy tested `7 3 l - 1 z
White - Customer's Copy Yellow -City Copy Pink - Tester's Copy