2012_0412CIIECK ONE.
IRRIGATION
DOMESTIC
FIRELINE
BACKFI,OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: L -�C',. f \"-P � �C� t`Q
The bacllfllow prcveation assembly detailed below has been tested and maiatained as requirzd by TNRCC
regular;ons and is testified to be operating within acceptable parameters.
TYPE OF ASSEMBLY
C _ Rexiuced Presstn-c Principle C Pressure Vacutmm Breaker
'_'�" Double Check Valve o Atmosphere Vacuum Breaker
Manufactiaer Si2c
Model Number
Serial Number
Located At
The above is certified to be true.
Fnm Name 1 c� n.r:. S �� c`p t'` �.�Y�- Certified Tests -
Firm Address �` �,� � � (� < , : ' \ S � � �Cert_ Tester No. Date
�5, (ocl
Gauge # i I C� "�� � � � �-1
Date last accuracy tested 3 - � F5 - aC 1
White - Customer's Copy Yellow -City Copy Pink - Testers Copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VACUUM BRFAil"F'IZ
Double Check Valve Assembly
1st Cheel:
2nd Cheek
Relief Valve
Air Islet
Check Valve
Initial Test
DC- Closed
Closed Tight �
Opened at
Opcaed at
nsid
Tight o'
Leaked o
nsid
nsid
RP- nsid
Leaked o
_
� a ' �,
Did not Open o
Leaked �
�P�rs
and
Materials
Used
Test Aftrs
DC- Closed
Closed Tight O
Opened at
Opened at
nsid
Repair
Tight 0
nsid
nsid
RP sid
The above is certified to be true.
Fnm Name 1 c� n.r:. S �� c`p t'` �.�Y�- Certified Tests -
Firm Address �` �,� � � (� < , : ' \ S � � �Cert_ Tester No. Date
�5, (ocl
Gauge # i I C� "�� � � � �-1
Date last accuracy tested 3 - � F5 - aC 1
White - Customer's Copy Yellow -City Copy Pink - Testers Copy