2012_1026CIIECK ONES
IRRIGATION DOMESTIC FIRELINE
BACi�T,OW PREVENTION ASSEMBLY TEST AND MAII�i'I ENANCE REPORT
NAME OF PwS: CITY OF COPPELL
PWS I.D_ #
LOCATION OF SERVICE:
The bacl�low prevention assembly detailed below has been 'tested and ma;n ;*+ed as required by TNRCC
regulations and is certified to be operating within acceptable parameters_
TYPE OF ASSEMBLY
C Rcduccd Pressure Principle C Pressure Vacuum Breaker
Double Check Valve o Atmosphere Vacuum Breaker
Manufacttaer - '�1 -�'Y)� `> Size �
Model Number �-,--' Located At ' `��� -�� ��
Serial Number � �l i
The above is certified to be true.
Firm Name 1 . L'�- � � /�' - '� //� Certified Tester
FirmAddrtss �C..13 �i�5�i4/ /"��Y��Cert. Test�No. Date
Gauge # ' �(S %/ fs �
Date last accuracy tested �%- �� -/�
White - Customer's Copy Yellow -City Copy Pink - Tester's Copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VACUUM BRE_�*T�'R
Double Chec3c Valve Assembly
1st Check
2nd Cbecl:
Relief Valve
Air Inlet
Check Valve
Initial Test
DC- Closed
Closed Tight !r7"
Opened at
Opened at
vsid
Tight Q
Leaked �
vsid
vsid
RP- vsid
Leaked �
Did not Open o
Leaked �
Repairs
and
Materials
Used
Test ARrs
DC- Closed
Closed Tight �
Opened at
Opened at
vsid
Repair
Tight o
vsid
vsid
RP sid
The above is certified to be true.
Firm Name 1 . L'�- � � /�' - '� //� Certified Tester
FirmAddrtss �C..13 �i�5�i4/ /"��Y��Cert. Test�No. Date
Gauge # ' �(S %/ fs �
Date last accuracy tested �%- �� -/�
White - Customer's Copy Yellow -City Copy Pink - Tester's Copy