2012_1026CIIECK ONE:
IRRIGATION DOMESTIC
FIRELINE
BACKFI..OW PREVENTION ASSEMBLY TEST ANL MAINTENANCE REPORT
NAME OF Pws: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: Cf U� Cf ± _ � �
The bac1.-flow prcvmtion assembly detailed below has bem tested and maintained as required by TNRCC
regulations and is ccx-cified to be operating within acceptable parameters_
TYPE OF ASSEMBLY
e Reduced Pressure Principle a Pressure Vacut_***+ Breaker
�_^_ Double Check Valve � Atmosphere Vacuum BreakQ
f
Maaufacttffer -
Size r
Model Number Located At �Ti�-- � -1�ir°
Serial Number
The above is certified to be true.
Firm Name � �-` ���' � �r -� "/ Certified Teste � >�' '' �T!!�s��- �
Firm Address r/� -- �-�'"� �/ /� /���ert. Tester No. Date 1� �G ��-
Gauge # .�U �l %� � � �
Date �ACt a��ura�y testes �� /6 -//
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VACUUM BRF'A�'R
Double Cber3c Valve Assembly
1st Checit
2nd Checl:
Relief Valve
Air Inlet
Check Valve
Initial Test
DC- Closed'.��
Closed Tigh�
Opined at
Opined at
vsid
Tight C7�
Leaked';�,�'i a
vsid
vsid
RP- vsid
L,�� o
Did not Opm o
Leaked �
RePa;.�
and
Materials
Used
Test ARer
DC- Closed
Closed Tight O
Opined at
Opined at
vsid
Repair
Tight D
vsid
vsid
RP sid
The above is certified to be true.
Firm Name � �-` ���' � �r -� "/ Certified Teste � >�' '' �T!!�s��- �
Firm Address r/� -- �-�'"� �/ /� /���ert. Tester No. Date 1� �G ��-
Gauge # .�U �l %� � � �
Date �ACt a��ura�y testes �� /6 -//