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2012_1129CHECK ONE. IRRIGATION_ DOMESTIC FIRELINE BACKFI.OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE The bacicflow prcvmtion assembly detailed below has been tested and maintained as required by TNRCC regulations and is certified to be operating within acceptable parameters_ TYPE OF ASSEMBLY e Rcduc� Pressure Principle C Pressure Vacuum Breaker ,R•i Double Check Valve � Atmosphere Vacuum Breaker Manufacturer i� � � p Size `'� Model Number� / � s /� Located At �G f�''C � � /�'C° " � Serial Numbers ' � S � �'' The above is certified to be true. Firm Name /� c f/ b �" r � � � Certified Testa !? � � c- w1 �l, /� /� s Firm Address �• �% � � � 7 ! 7 �� /9- X /% � Ce:t Tester No. 1'� %� ©0 0 0 ,off Date !) -� Y ' /� `; . Gauge # O (r O `l / 7 � � Date last accuracy tested `"` -l� -%� White - Customer's Copy Yellow -City Copy Pink - Tester's Copy REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUCTM BRFasr�'R Double Check Valve Assembly 1st Check Sad Check Relief Valve Air Inlet Check Valve Initial Test / DC- Closed Tight o Closed Tight o Leaked o Opined at osid Opened at osid osid /'A i RP- osid �� p Did not Opm o Leaked � Repaus and Materials Used Test After Repair DC- Closed Tight o Closed Tight a Opened at osid Opened a[ osid osid RP sid The above is certified to be true. Firm Name /� c f/ b �" r � � � Certified Testa !? � � c- w1 �l, /� /� s Firm Address �• �% � � � 7 ! 7 �� /9- X /% � Ce:t Tester No. 1'� %� ©0 0 0 ,off Date !) -� Y ' /� `; . Gauge # O (r O `l / 7 � � Date last accuracy tested `"` -l� -%� White - Customer's Copy Yellow -City Copy Pink - Tester's Copy