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2012_1025CIIECK ONE= IRRIGATION DOMESTIC FIRELINE BACKFT.OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT IJ�ti�a7oi�:ily PWS I.D. # CITY OF COPPELL LOCATION OF SERVICE: /�� y c j Yl..f' �Gr�- tiU��.✓ G- The baci�low prcvmtion assembly detailed below has bees tested and maintained as required by TNRCC regulations and is certified to be operating within acceptable parameters. C Reduced Pressure Principle •�^- Double Check Valve Manufact�ser Model ivumber ��p Serial Ivttmba � 2 %� O TYPE OF ASSEMBLY c Pressure Vag-+*+***+ Breaker o Atmosphere Vacuum Breaker Size ✓ Located At ' �'`if : < , f- The above is REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BRE_AT�'R Double Check Valve Assembly Firm Name "� : �-^-1i /' i �/. Certified Testa �f � / - !� eT�Y7'cr'S �5- {'y/ /- ` %��-�7 - 1st Cheek 2nd Checl: s CeR Testa No. Relief Valve Air Inlet Check Valve Initial Test DC- Closed 1 � ' Closed Tight Opined at Opened at nsid Tight © Leaked � nsid nsid RP- nsid I„caked p Did not Opm D Leaked � �P�� and Materials Used Test Alta DC- Closed Closed Tight o Opened at Opened at nsid Repair Tight Q nsid ysid RP sid The above is certified to�be trot. Firm Name "� : �-^-1i /' i �/. Certified Testa �f � / - !� eT�Y7'cr'S �5- {'y/ /- ` %��-�7 - Firm Address yGY) 7l✓ �� ti'( i "'a.�� s CeR Testa No. � �1� -% � Date /� ` �� ' �_�1- Gauge # /� d % / �� Date last accuracy tested / � - �<%, - -� White - Customer's Copy Yellow -City Copy Pink - Tester's Copy