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2012_0612
CHECK ONE. IRRIGATION DOMESTIC �' FIRELINE BACKFLOW PREVENTION ASSEMBLY TEST AND CE REPORT NAME OF PWS_ PWS LD_ # CITY OF COPPELL LOCATION OF SERVICE= ��GL7 �Y-� t7v r �' The bac.L - flow prevention assembly detailed beiow bas been tested and maintained as required by TNRCC regulations and is certified to be operating within aaxptablc parameters_ a Reducod Pressure Principle � Double Check Valve Ivfaaufacnacr 1.1./dt -<-�- S Model Nnmber a7 71�-t / Serial Number � 5 b Gl 2 TYPE OF ASSEMBLY a Ptzsstae Vag Brealoer a Atmospherz Vacmmm Breaker rLi, Sim S �,e -�rri At �' In.' �G� i2.Al-La^ �.. l�n.L��r -�✓' The above is certified to be true_ Firm Name � ,4'1 ©V1 �i IZ -ls. �20� Certified Tester l %t2.So� kttl C �Ca�.3 Fnm Address 1~bC3r�,c �g � i,y[h� L�a,¢L..� a Cent. Testa No. �� t o� S I Dace ___c_� i _I / 2. T� Gauge # c7(� I IOC3�� Date Iast accuracy tested °I � 15 1 I White - Customer's Copy Ye11ow -City Gopy Pink - Tester's Copy REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BRr�T�it Double CLFcIc Valve Assembly ist Check 2nd Cbeelc Relief Valve Air Inlet Cbedc Valve Initial Test DC- Closed (. 8 Clod Tight � Opened at Opened a mid Tight � Leal-ed o osid raid RP- ._,paid i ..�1 -.�ri � � � �P Did not Open o L.eaioed a Repans and jylat'.�ia1c Used Tess ARet DC- Closed Closed Tight o Opeaai at Opcaod at _paid Repair Tight o raid RP The above is certified to be true_ Firm Name � ,4'1 ©V1 �i IZ -ls. �20� Certified Tester l %t2.So� kttl C �Ca�.3 Fnm Address 1~bC3r�,c �g � i,y[h� L�a,¢L..� a Cent. Testa No. �� t o� S I Dace ___c_� i _I / 2. T� Gauge # c7(� I IOC3�� Date Iast accuracy tested °I � 15 1 I White - Customer's Copy Ye11ow -City Gopy Pink - Tester's Copy