2012_1025CIIECH ONE:
IRRIGATION DOMESTIC FIRELINE
BACKFI.OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: /C �� � /.�-r�.,�v'.- %ot,�� �.._
The baci�low prevention assembly detailed below has been tested and maintained as required by TNRCC
ragulatiotLS and is ccc-tified to be operating within acceptable parameters_
TYPE OF ASSEMBLY
C Reduced Pressure Prmctplc c Pressure Vac+n•**• Breaker
LT'" Double Check Valve C Atmosphere Vacuum Breaker
Manufactttrcr ��°"�}�� ^"'�� Size
Model Number '�,ti.V� Located At s %''.
Serial Number
The above is certified to be true.
Firm Name > z- `t�� / Certified Tester r .
Firm Address ''�!� 7��f =, � �/K ��G' -' Cert Tester No. Date
i
Gauge # � �� /� �
Date Iast accuracy tested ! �� -/6 _
White - Customer's Copy Yellow -City Copy Pink - Tester's Copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VACUUM BREAKER
Double Cheek Valve Assembly
1st Check
2nd Checl:
Relief Valve
Air Inlet
Check Valve
Initial Test
DC- Closed ,�; �
,Closed Tight
Opened at
Opined at
nsid
Tighe rd'
Leaked j o
nsid
nsid
RP- nsid
_ .,:
`-�
Lcaled C
Did not Opm o
Leaked �
Repairs
and
Materials
Used
Test ARtr
DC- Closed
Closed Tight a
Opened at
Opined at
nsid
Repair
Tight t7
nsid
nsid
RP sid
The above is certified to be true.
Firm Name > z- `t�� / Certified Tester r .
Firm Address ''�!� 7��f =, � �/K ��G' -' Cert Tester No. Date
i
Gauge # � �� /� �
Date Iast accuracy tested ! �� -/6 _
White - Customer's Copy Yellow -City Copy Pink - Tester's Copy