2012_1012 (3)CIIECK ONE.
IRRIGATION DOMESTIC FIRELINE �/
BACI�ZOW PREVENTION ASSEA�LY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPYELL
PWS I.D. #
LOCATION OF SERVICE: ,r /%� ��c��.�.�•�� -.
The bacldlow prevention assembly detailed below has been tested aad maintaiaed as required by TNRCC
reeulations and is certified to be operating within acceptable parameters_
TYPE OF ASSEMBLY
Reduced Presstu-c Principle C Pressure Vacutmz Breaker
Double Chctlk Valve � Atmosphere Vacuum Breaker
Manufacturer C�✓� -� Size �/ 3�� 1
Model Number O> °7iy+i c1�% Located At �a�"t -��� F--G�( S � �'- °�i� g % ��-
Serial Number -1�-±� � �a�-Qo -
The above is certi£ed to be true.
Firm Name Li r'�.c.er- ��'
Firm Addrsss � o �lL- � �-7 �% ^ ° - -�
Gang¢ # �? i O C� O � ��
Dat¢ Last accuracy t¢st¢d ` % 3 i- J "1
Certified Tester � � �-� .� �'� - t? �v �- �
Cert. Testa No. 13 Pos�v 6 /S --� Date / J - 1 L 1 �
White - Custom¢r•s Copy Y¢llow -City Copy Pink - Test¢rs Copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VACUUM BI2�'A�'R
Double Check Valve Assembly
1st Checl: /. �
tad Checi: %, = -
Relief Valve
Air Inlet
Check Valve
Initial Test
DC- Closed
Closed Tight ~�
Opened at
Opined at
nsid
Tight
Leaked �
nsid
nsid
RP- nsid
I.eal:ed o
Did not Opm O
Leaked �
RePairC
and
Materials
Used
Test After
DC- Closed
Closed Tipp. ht o
Opined at
Opmod at
nsid
Repair
Tight o
nsid
nsid
RP sid
The above is certi£ed to be true.
Firm Name Li r'�.c.er- ��'
Firm Addrsss � o �lL- � �-7 �% ^ ° - -�
Gang¢ # �? i O C� O � ��
Dat¢ Last accuracy t¢st¢d ` % 3 i- J "1
Certified Tester � � �-� .� �'� - t? �v �- �
Cert. Testa No. 13 Pos�v 6 /S --� Date / J - 1 L 1 �
White - Custom¢r•s Copy Y¢llow -City Copy Pink - Test¢rs Copy