2012_1026CIIECH ONE.
IRRIGATION DOMESTIC FIRELINE
BACKFI.OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I_D_ #
LOCATION OF SERVICE: �� 7' �� �`f�'�- l�- /�G�t,�r^ o -
c
The bacicflow prcvmtion assanbly detailed below has bem tested and maintained as required by TNRCC
regulations and is certified to be operating within acceptable parameters_
TYPE OF ASSEMBLY
e Reduced Pressure Principle c Pressure Va�sri Breaker
�^. Double Check Valve � Atmosphere Vacuum Breaker
Manufacturer � ���' ✓�'` "�
Model Number ?C°�� �
Serial Number / (-� �,�
Size
Located At �c/7', <. c_i;,�?__
The above is certified to be true.
Firm Natne
Firm Address
Gauge #
Date last accuracy tested
White - Customer's Copy
Certified Tester
Cat Testa• No. Date
Yellow -City Copy
Pink - Tester's Copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VACUUM BREAKER
Double Check Valve Assembly
1st Check
2nd Check
Relief Valve
Air Inlet
Cheek Valve
Initial Test
DC- Closed
Closed Tight o
Opined at
Opined at
nsid
Tight �
Leaked 0
vsid
vsid
RP- nsid
�;� p
Did not Opm o
Leaked �
�P�s
and
Materials
Used
Test After
Repair
DC- Closed
Tight o
Closed Tight v
Opined at
vsid
Opened at
nsid
nsid
RP sid
The above is certified to be true.
Firm Natne
Firm Address
Gauge #
Date last accuracy tested
White - Customer's Copy
Certified Tester
Cat Testa• No. Date
Yellow -City Copy
Pink - Tester's Copy