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2012_1129 (3)CIIECK ONE. IRRIGATION DOMESTIC FIRELINE � BACI�T.OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPYELL PWS I.D. # LOCATION OF SERVICE: � 3 S %-� � � �� �' The bacicflow prevention 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 C Reduced Pressure Principle C Pressure Va�-+�***+ Bzeaker `�( Double Ch /eck Valve O Atmosphere Vacuum BreakQ Manufacturer �/>' � �`� size Model N "immber � �� �7 �� / Locatad Ai �/SG �� / r�:- j= /tO,d� -7� Serial Number � � U � � The above is certified to be true. y� Fitm Name /7/j�'/ � � �.� t - /•�� Cetifiod Tester / " /l�e � ��i �� � Firm Address / ' ©. /jO � 7 y 7 �/i,QOc/�- CTT Tests No. �3�01ioo7�" -Z Dace l l �a g �.� Gauge # �� G `ii � �` Date last accuracy tested G/ �/� �� Wtute - Customer's Copy YeIIow -City Copy Pink - Tester's Copy REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAi�R Double Check Valve Assembly 1st Checl: 2nd Check Relief Valve Air Inlet Check Valve Initial Test DC- Closed � Closed Tight � Opened at Opined at nsid Tight i31` Leaked � 0 D nsid nsid R.P- vsid 1„c�� p Did nos Open o Leaked � Repairs and Materials Used Test After DC- Closed Closed Tight v Opined at Opined at vsid Repair Tight o vsid vsid RP sid The above is certified to be true. y� Fitm Name /7/j�'/ � � �.� t - /•�� Cetifiod Tester / " /l�e � ��i �� � Firm Address / ' ©. /jO � 7 y 7 �/i,QOc/�- CTT Tests No. �3�01ioo7�" -Z Dace l l �a g �.� Gauge # �� G `ii � �` Date last accuracy tested G/ �/� �� Wtute - Customer's Copy YeIIow -City Copy Pink - Tester's Copy