2012_1026CIIECK ONE.
IRRIGATION DOMESTIC FIRELINE
BACTCF'I.OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D_ #
LOCATION OF SERVICE: -r. t:: -`
The bacl�low prevention assembly detailed below has been tested and maintained as requimd by TNRCC
regulations and is certified to be operating within acceptable parameters_
TYPE OF ASSEMBLY
C Reduced Pressure Pzznc3ple C Pressure Vag+++*+*+ Breaker
.. Double Check Valve C Atmosphere Vacuum Brralrr
Manufacturer � �7'll'ti� -Q `'�
Model Number
Serial Number � !rs'G(
Size
Located At ( � ��- �- Q� -.1%'
The above is certified to be true.
Firm Name � •lit /' , f� i r-C� � Certified Tester
Firm Address ,/ �'��"Sf' � r ��" f Cent. Tester No. Date
Gauge # / �O �/ �.S
Date Iast accuracy testes /� / / — /''
Wlute - Customer's Copy Yellow -City Copy Pink - Tester's Copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VACUUM BRF��R
Double Check Valve Assembly
1st Check
2nd Checl:
Relief Valve
Air Inlet
Cheek Valve
Initial Test
DC- Closed
Closed Tight 1�`"
Opined at
Opened at
nsid
Tight D'
Leaked o
nsid
nsid
RP- vsid
�;� p
Did not Opea o
Leaked �
Repairs
and
Materials
Used
Test Afars
DC- Closed
Closed Tight D
Opined at
Opined at
nsid
Repair
Tight o
nsid
nsid
RP sad
The above is certified to be true.
Firm Name � •lit /' , f� i r-C� � Certified Tester
Firm Address ,/ �'��"Sf' � r ��" f Cent. Tester No. Date
Gauge # / �O �/ �.S
Date Iast accuracy testes /� / / — /''
Wlute - Customer's Copy Yellow -City Copy Pink - Tester's Copy