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: Li / �-
The bacl�low pmmtion assembly detailed below has been tested and maintained as required by TNRCC
regulations and is certified to be operating within acceptable parameters.
C Reduced Pressure Principle
Double Check Valve
Manufacturer �c -�-- rY7�'�-�
Model Number r-�? CXY') 1 �
Serial Number L��7 7 Y� r�
TYPE OF ASSEMBLY
C Pressure Vacuum Breaker
C Atmosphere Vacuum Breaker
Size
Located AL
The above is certified to be true.
Firm Name '� ° ✓' , �= f/ � "�--
Firm Address .�ilNr(c� -A� �- �l,
Gauge # ,'i�7 f �_� C__.
Date last accuracy tested / %�� -,, /f
Catified Testa
Cert. Testa No. Date
White - Customer's Copy Yellow -City Copy Pink - Tester's Copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VACUUM BRE_�►�R
Double Check Valve Assembly
1st Chec]c
2nd Checl:
Relief Valve
Air Inlet
Cheek Valve
Initial Test
DC- Closed
Closed Tight o
Opined at
Opined at
osid
Tight C
Leaked D
osid
osid
x'
RP- nsid
Leaked C
Did not Open o
Leaked O
Rcpaus
and
Materials
Used
Test ARer
DC- Closed
Closed Tight o
Opened at
Opened at
nsid
Repair
Tight �
_ nsid
nsid
RP sid
The above is certified to be true.
Firm Name '� ° ✓' , �= f/ � "�--
Firm Address .�ilNr(c� -A� �- �l,
Gauge # ,'i�7 f �_� C__.
Date last accuracy tested / %�� -,, /f
Catified Testa
Cert. Testa No. Date
White - Customer's Copy Yellow -City Copy Pink - Tester's Copy