2012_0612 (3)CIIEGK ONE:
IRRIGATION
DOMESTIC
FIRELINE
BACI�Z.OW PREVENTION ASSEIrIBLY TESL' AND G� REPORT
NAME OF FWS:
PWS LD_ #
CITY OF COPPELL
LOCATION OF SERVICE_ �bJ � Q t� sv�- oanc.�
The baci-f]ow prev�rico assembly detailed blow has bem resod tied maiaraiaod as tzquized by TNRCC
zz_aulstions aad is certified to be operating within acceptable paramttas.
Model Number
Reduced Pressuae Principle
Double Check Valve
i
.i �
serial Number 6 [ ! / 5
TYPE OF ASSElvlBLY
c Pressure Vacutna Breaioer
� Atmosphere Vacmtm Breaks
Size
2 i�
Located At N E Corc r._.�✓ � rtte�e .r
The about is certified to be true. [l4S�k � S7a til
F'um Name �-�-t � ✓( �(2-t: '�RO Ceztified Tester aPOOJ OCo-S �
Firm Address /���aiD)C Z� 7 /�(JI.�W�� � Cert. Testa No. Dace l� % /T2
Gauge # �P / %Lj %s
Date last accuracy tested _��L_
wtute - customer's copy Yellow -City Copy Pink - TesteCs Copy
REDUCED PRESSURE PRINCIPLE ASSEl►�LY
PRESSURE VAC[ILTM BR>L'�t�R
Double Chtdc Valve Assembly
1st Check
2nd ChecL-
Relief Valve
Air Iaiet
Cbeeit Valve
Initial Test
DC- Closed
Closed Tight O
Opined at
Opened at
nsid
Tight o
t ^mil -.Yi O
osid
osid
Rp- veld
Leaked a
Did aoc Opm o
L.mkod �
�P�
tied
jVjar...;ate
Used
Test AR,er
DC- Closed
Closed Tight v
Opened at
Opened at
_paid
Repair
Tight a
Held
osid
RP 'd
The about is certified to be true. [l4S�k � S7a til
F'um Name �-�-t � ✓( �(2-t: '�RO Ceztified Tester aPOOJ OCo-S �
Firm Address /���aiD)C Z� 7 /�(JI.�W�� � Cert. Testa No. Dace l� % /T2
Gauge # �P / %Lj %s
Date last accuracy tested _��L_
wtute - customer's copy Yellow -City Copy Pink - TesteCs Copy