2012_1012 (4)CHECK ONE: /
IRRIGATION DOMESTIC FIRELINE "/
BACKFi.OW PREVENTION ASSEII�LY TEST AND CE REPORT
NAME OF PWS:
CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: %%0 % C
The bate -Flow pravmnion assetnbiy detailed below has bcm tesncd and mainrained as requited by TNRCC
regulations ammd is certified to be operating withia acceptable parameters.
TYPE OF ASSEMBLY
C Reduced Pressure Priaciplc C Pressm'e Vartwm+ Breaker
t0� Double Check Valve Q AtmosphQe Vacuum Breaker
Manufacturer ��� Sizc � /�vn Q _/�
Modei Number �� % �%d� I- orated At 4�J � ��. •' 7� ��" '
Serial Number �-
The above is eatified to be true.
Firm Name � v�•-� � ��._ Certified Testa i[ e n n.��^ -- �- «� -'�-�
Firm Address P v �9 � 7 ti � /�� Cent Testa No. 8 Po.� 6 !S -'7 Date / ° " / L- � a
Gavg¢ # v-��y �Zf-�B
Dat¢ Iast accuracy tested '� 3 /— / z-
wait¢ - customer's Copy Yellow -City Copy Pink - Tester's Copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VACLTLJM BRE_sX'F'�
Double Cheep Valve Assembly
Relief Valve
Air Ialet
Cltecic Valve
Ist Check �,
2nd Checlt � • `�
Initial Test
DC- Closed
Tight
Closed Tight �
i ..�t;eYi D
Opened at
tfsid
Opened at
osid
osid
RP- osid
�� p
Did not Open o
Leaked �
Repairs
and
Materials
Used
Test ARnr
Repair
DC- Closed
Tighe a
RP "d
Closed Tight O
Opened az
osid
Opened at
osid
�d
The above is eatified to be true.
Firm Name � v�•-� � ��._ Certified Testa i[ e n n.��^ -- �- «� -'�-�
Firm Address P v �9 � 7 ti � /�� Cent Testa No. 8 Po.� 6 !S -'7 Date / ° " / L- � a
Gavg¢ # v-��y �Zf-�B
Dat¢ Iast accuracy tested '� 3 /— / z-
wait¢ - customer's Copy Yellow -City Copy Pink - Tester's Copy