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2012_1129 (2)CIIECK ONE. IRRIGATION DOMESTIC FIRELINE /� BACKFT.OW PREVENTION ASSEMBLY TEST AND Mp►INTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE: �0 3 S % � � e �� � The baci. -flow prevention assembly detailed below has been tested and maintained as required by TNRCC reeuiations and is certified to be operating within acceptable parameters. C Reduced Presstn-e Principle t�l Double Check Va1vc Manufacttaer � /¢ � � S Model 2�iumber Serial Nttmber � Lr, © �-/ % /� TYPE OF ASSEMBLY C Pressure Vag-+*+**++ Breaker C Atmosphere Vacuum Breaker Size , / Located At y � � � � f� � r'�� `� � The above is c/eJrtifi/ed to be true. Firm Name /� C/- /O �� /� � �� Certified Tests /%�i � ` � L� ��i �9 � 5 Firm Address � � /jo K 7 �f � G �'� s�f�- � CortS�T Sesta No. � %,C'''oo o %�`l Dau �/ ��� -l-Z Gauge # GAG o mil/ ? ��' Date last accuracy tested �l l.� �� White - Customer's Copy Yellow -City Copy Pink - Tester's Copy REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BRFATt�'R Doub►e Check Valve Assembly 1st Check 2nd Check Relief Valve Air Inlet Check Valve Initial Test DC- Closed .� Closed Tight _ a Opined at Opined at nsid Tight Y 4�: Leaked �( nsid nsid RP- nsid �G Leaked C Did not Opm o Leaked � Repairs and Materials used Test Aites DC- Closed Closed Tight o Opened at Opined at nsid Repair Tight o nsid nsid RP sid The above is c/eJrtifi/ed to be true. Firm Name /� C/- /O �� /� � �� Certified Tests /%�i � ` � L� ��i �9 � 5 Firm Address � � /jo K 7 �f � G �'� s�f�- � CortS�T Sesta No. � %,C'''oo o %�`l Dau �/ ��� -l-Z Gauge # GAG o mil/ ? ��' Date last accuracy tested �l l.� �� White - Customer's Copy Yellow -City Copy Pink - Tester's Copy