2012_1026CIIECK ONE.
IRRIGATION
DOMESTIC
FIRELINE
BACKFI.OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: % i) � � � -�'t� C—�._-
The bacidlow prevmtioa assembly detailed below has bees ttsted and maintained as required by TNRCC
rz`sulations and is certified to be operating within acceptable parameters_
C Rcduccd Pressure Principle
-C� Double Check Valve
Maaufactta-er 7��J �>
Model Number 1s� R���
Serial Number � C`� � �'
TYPE OF ASSEMBLY
C Pressure Vacutmm Breaker
o Atmosphere Vacuum Breaker
Size
Located At
The above is certifiod to be true.
Firm Name 5 - W���- . l- CertiSted Tester
Firm Address .�G7iY5- til /G'� �%�+ Cent Tester No_ �� � "� Date �y ` ��.
Gauge � !rho -7�' �G
Date last accuracy tested ;�� �6 ��
White - Customer's Copy Yellow -City Copy Pink - Tester's Copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VAG'[7LTM BRF'A�'R
Double Cherlc Valve Assembly
Relief Valve
Air Inlet
Check Valve
1st Check
2nd Cheek
Initial Test
DC- Closed
Tight �
Closed Tight C3
Leaked o
Opened at
nsid
Opened at
osid
osid
RP- nsid
�� p
Did not Opea o
Leaked �
�Paz�
and
Materials
Used
Test After
Rapair
DC- Closed
Tight [7
Closed Tight o
Opened at
nsid
Opened at
nsid
nsid
RP std
The above is certifiod to be true.
Firm Name 5 - W���- . l- CertiSted Tester
Firm Address .�G7iY5- til /G'� �%�+ Cent Tester No_ �� � "� Date �y ` ��.
Gauge � !rho -7�' �G
Date last accuracy tested ;�� �6 ��
White - Customer's Copy Yellow -City Copy Pink - Tester's Copy