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2012_1025CIIECK ONE. IRRIGATION DOMESTIC FIRELINE BACKFT.OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE: �� ` �� _� ^/�rlXit /c^!t�tf�"F� The bacicflow prevmtion assembly dctaiied below has bem tested and maintained as required by TNRCC regulations and is certified to be operating within acceptable parameters" C Rcduccd Pr�esstn-c Principle Double Check Valve Manufacturer ��- -p"'`�-Q -� Model Number --� � Serial Number � � � �` j TYPE OF ASSEMBLY C Pressure Vacuum Breaker D Atmosphere Vacuum Breaker r Size ::. _ .. Located At ". r' <.�d.l'+ ��- >�__ -�__ The above is certified to be true. Firm Name [.c1 d r-c . r `��c� /ii" � Certified Tests ,;;• __. Firm Addriess `' ©C) 7- .�.`f� �Litf �� rx�Cert Tester No. Date __ Gauge # �',� ?/� 7!'�� �C � / Date last accuracy tested �j ' �� -� White - Customer's Copy Yellow -City Copy Pink - Testers Copy REDUCED PRESSURE PRINCIPLE ASSEl�LBLY PRESSURE VACUUM BRE_�*T�'R Double Check Valve Assembly 1st Check tad Chek: Relief Valve Air Inlet Cheek Valve Initial Test DC- Closed .Closed Tighe Opmed at Opmed at nsid Tight �" ®`� Leaked o nsid nsid RP- vsid __- I.eaiced o Did not Opm o Leaked � Repairs and Materials Used Test AR,er DC- Closed Closed Tight o Opmed at Opined at nsid Repair Tight a vsid vsid RP sid The above is certified to be true. Firm Name [.c1 d r-c . r `��c� /ii" � Certified Tests ,;;• __. Firm Addriess `' ©C) 7- .�.`f� �Litf �� rx�Cert Tester No. Date __ Gauge # �',� ?/� 7!'�� �C � / Date last accuracy tested �j ' �� -� White - Customer's Copy Yellow -City Copy Pink - Testers Copy