2012_1127CIIECK ONE.
IRRIGATION �//
DOMESTIC
FIRELINE
BACKFI.OW PREVENTION ASSE1vIBLY TEST AND MAINTENANCE REPORT
NAME OF PWS. CITY OF COPPELL
PWS I.D_ # LGt_1�� IL ►-� ��Gj
LOCATION OF SERVICE: y4, I G' `." � '� ` k � z-
The bacicflow prevention assembly detailed below has bees tested and =na,nrained as required by TNRCC
regulations and is certified to be operating within acceptable parameters_
TYPE OF ASSEMBLY
C Reduced Pressure Principle C Presstu-e Va�-uL�**+ Breaker
Double Check Valve � Atmosphere Vacuum Breaker
Maaufacatrer Size
Model Ntmmber
Scria! Number
Located At : + , � f � } C�.d � �i.
r T1:� ��
t i' y_
The above is certified to be true.
Firm Natne 1 � - 1 1 �' � `-
FirmAddress � } i,' �f��R C'li � ;' ..
}: ; � I
Gauge # _ -- - _ -`- - -
Date last accuracy tested
Certified Tester _
Cent_ Tester No. ` ' Date
White — Customer's Copy Yellow —City Copy Pink — Tester's Copy
REDUCED PRESSURE PRINCIPLE ASSEirIBLY
PRESSURE VAC[.TLTM B���R
Double Cheek Valve Assembly
1st Check
tad Checl:
13e1ief Valve
Air Islet
Check Valve
Initial Test
DC- Closed
TiQitt �
� losed Tight
Leaked � o
Opened at
nsid
Opined at
nsid
nsid
RP- � nsid
Leaked p
Did not Opm o
Leaked �
Repaus
sad
Materials
Used
Test Af%r
Repair
DC- Closed
Tight Q
Closed Tight o
Opened at
nsid
Opined at
nsid
nsid
RP sid
The above is certified to be true.
Firm Natne 1 � - 1 1 �' � `-
FirmAddress � } i,' �f��R C'li � ;' ..
}: ; � I
Gauge # _ -- - _ -`- - -
Date last accuracy tested
Certified Tester _
Cent_ Tester No. ` ' Date
White — Customer's Copy Yellow —City Copy Pink — Tester's Copy