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2012_0420CIIECK ONE: IRRIGATION DOMESTIC � FIRELINE BACKFI.OW PREVENTION ASSEMBLY 'PEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # N LOCATION OF SERVICE: �- �, � 1 fir�C Ptas`'i -" P1�� `f The bacicIIow prcvmtion assembly detailed below has bem tested and ma;nra;nCd as required by TNRCC rcQUlations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY C Reduced Pressure Priacipic C Pressure VacuLr*+ Br+ealcer Double Check Valve o Atmosphere Vacuum Breaker ai Manufacturer �� :' � � � � Size Modci Ntmzber �,-5 fl Located At ►� ► S �' �. ©pi►'t Serial Number � j D � � .3 The above is certified to be true. Firm REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BR�aKFR Double Cheek Valve Assembly Cetified Tester 1..io -�T,�C Ql�''''�� Firm Address 1st Cheri: 2nd Cheri: Cert Tests No� ©O'3 Z 8 � Relief Valve Air Inlet Check Valve Initial Test DC- Cloy�j Closed Ti�f Opened at Opined at osid iyL��L� �''°` Tilt `'z RP- osid Leaked o osid osid Leaked p Did not Opm o Leaked � �Pazrs and Materials Used Tess After DC- Closed Closed Tight o Opined at Opined at osid Repair Tight o Dsid osid RP sid The above is certified to be true. Firm Name � J`�S �. �`� �1QLi� %L � Cetified Tester 1..io -�T,�C Ql�''''�� Firm Address / ©a-6 5 /%�. � fit-/' � �/ o � Cert Tests No� ©O'3 Z 8 � Date u �O �- Gauge # 2L�% `i tL y Date last accuracy tested �� I �— White - Customer's Copy Yellow -City Copy Pink - Tester's Copy