2012_1025CIIECK ONE.
IRRIGATION
DOMESTIC
FIRELINE
BACKFT.OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
IJ`T�a77iii. +l.7
PWS I.D- #
CITY OF COPPELL
LOCATION OF SERVICE: � ��f� �c�r-�,r�.1 G`F'' -
The bacl�low prcvmtion assembly detailed below has bem tested and maintained erg squired by TNRCC
rtgulations and is certified to be operating within acceptable parameters_
C Reduced Pressure Principle
-� Double Check Valve
� �1
Maaufacturer l`f%/1'�
Model Nmaber � _�C7Z9iO
Serial Number � � � 7 �-3
TYPE OF ASSEMBLY
C Pressure Va�-+n�**+ Breaker
o Atmosphere Vacuum Breaker
Size j
Located At � �o
The above is certified to be true.
Firm Name � ' , / r �
Firm Addtrss !'''r� - ��^�y�'iG / /�R^
��
Gauge # /� 7i�s G
Date last accuracy tested %/- /� - /�
Certified Tests _
-.
Cent Testa No. Date --
White - Customer's Copy Yellow -City Copy Pink - Tester's Copy
REDUCED PRESSURE PRINCII'LE ASSEMBLY
PRESSURE VACUUM BRF'AT�R
Double Check Valve Assembly
1st Check
2nd Checl:
Relief Valve
Air Inlet
Cheek Valve
Initial Test
DC- Closed
Closed Tight o
- med at
Opined at
nsid
Tight o
Leaked
nsid
nsid
RP- nsid
Leaked ��
•i ,�.� � /
Did not Open o
Leaked �
Repa;�
and
Materials
Used
Test Auer
DC- Closed
Closed Tight o
Opined at
Opined at
nsid
Repair
Tight o
nsid
nsid
RP sid
The above is certified to be true.
Firm Name � ' , / r �
Firm Addtrss !'''r� - ��^�y�'iG / /�R^
��
Gauge # /� 7i�s G
Date last accuracy tested %/- /� - /�
Certified Tests _
-.
Cent Testa No. Date --
White - Customer's Copy Yellow -City Copy Pink - Tester's Copy