2012_0612 (4)CIIECK ONES
IRRIGATION
DOMESTIC
FIB.ELINE
BACIQ'Z.OW PREVENTION ASSEMBLY TESL' AND CE REPORT
NAME OF PVVS:
CITY OF' COPPELL
PWS LD- # I' /
LOCATION OF SERVICE: � O � �Q )'V� �/l(� ✓�Gf
The bacl-tlow prcveation assembly deviled below has bem tested and maintained as zzgritsd by TNRCC
r+cgulatiaas sad is cernified to be e�peradng within acceptable parameters_
TYPE OF ASSEMBLY
a Reduced p�,e Priacipie a Press�ae Vaeetamz Breal�r
Double Check Valve a Atmosphere Vacuum Brealaer
Maaufaeaatr ji(JCk -L-�S Size � ei
Modei I�iumber �'77' 17 G � A Located At s � �/,2� Llat � `�
Serial Number �Gl� Z� D
The above is c�s'tified to be trete.
Fnm Name � C�-; v � ^. � n � P� o S CertiBod Tester �%� Cn v. mfr � S'-TO w.J
Fism Address � �r»t 79 7 / 4.Gx r�.r lst� X � Cert. Tester No. BOLA / d6 S / Dsu TT Z
Gauge # b !.� / I ob"7 S
Date last accuracy tested � /�,�
white - Customer's Copy Yellow -City Copy Pink - TesceCs copy
REDUCED PRESSiJRE PRINCIPLE ASSEMBLY
PRESSiJRE V,CULTM SREAI�A
Double CL�eck Valve Assembly
Iat Check
tad Chec3c
Relief Valve
Air Inlet
CLedc Valve
Initial Test
DC- Closed Z. �o
Tight �
Closed Tight �
L,caixd a
Opened at
acid
Opened a
acid
°mod
RP -�sid
i �.�� o
'Z - y
Did aot Open o
Leai:ed o
�P�
and
lylat..r: ale
Used
Test A$er
DC- Closed
Closed Tight o
Opeaod at
Opened at
?�
Repair
Tight o
osid
acid
RP
The above is c�s'tified to be trete.
Fnm Name � C�-; v � ^. � n � P� o S CertiBod Tester �%� Cn v. mfr � S'-TO w.J
Fism Address � �r»t 79 7 / 4.Gx r�.r lst� X � Cert. Tester No. BOLA / d6 S / Dsu TT Z
Gauge # b !.� / I ob"7 S
Date last accuracy tested � /�,�
white - Customer's Copy Yellow -City Copy Pink - TesceCs copy