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2012_1026CIIECK ONE: IRRIGATION DOMESTIC FIRELINE `' BACKFi.OW PREVENTION ASSEII�LY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE: /r��- �!� %'�� " -�' 'J�T�J C`�C.s.�CP The baelcflow prcvmtion assembly detailod below has bcea tasted aad maintained ag required by TNRCC reetrlations aad is certified to be operating within acceptable parameters_ TYPE OF ASSEMBLY c Reduced Pressure Principle a Pressure Vacut� Breaker _ 6 Doubl`e� Check Valve o Atmosphere Vacutrm Breaker Maaufactraer �� 1�yrr-P S Size Model N�ber � �[7c7 � Located At - Serial Number�� !j The above is certified to be trrre- Firm Name Firm Address Gauge # Date Iast accuracy tested Certified Tester Cert. Tester No_ Date White - Customer's Copy Ye11ow -City Copy Pink - Tester's Copy REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BRE_A�'R Double Cheek Valve Assembly 1st Check 2nd Cbecl: Relief Valve Air Inlet Check Valve Initial Test DC- Closed _ Tight © Closed Tight eY' Leaked � Opined at nsid Opined at nsid nsid RP- nsid �� p Did not Opea o Leaked � Rcparrs and Materials Used Test ARu Repair DC- Closed Tight � Closed Tight D Opened at vsid Opined at vsid nsid RP sid The above is certified to be trrre- Firm Name Firm Address Gauge # Date Iast accuracy tested Certified Tester Cert. Tester No_ Date White - Customer's Copy Ye11ow -City Copy Pink - Tester's Copy