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2012_1025CIIECK ONE: IRRIGATION DOMESTIC FIRELINE BACKFI.OW PREVENTION ASSE1rIBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE: The baclfllow ptzvmtion assembly detailed below has bem tested and maintained as required by TNRCC regulatiorts and is certified to be operating within acceptable parameters_ TYPE OF ASSEMBLY C Reduced Pressure Principle C Pressure Vacu++**+ Braaker --ei" Double Check Valve C Atmosphere Vac�n�**+ Brtaler Maaufacttaer Model Number Serial Number Size Located At The above is certified to be true. Firm Name , Gv, ' .-� - ; -� Certified Tests - Firm Address y � z• � Cent Tester No. Date Gauge # /i}�'? �lv�� Date last accuracy tested !!- !�! White - Customer's Copy Yellow -City Copy Pink - Testers Copy REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BR>:'.►rrFR Double Cheek Valve Assembly 1st Check 2nd Cheri: Relief Valve Air Inlet Cheek Valve Initial Test DC- Closed Closed Tight -[3 Opined at Opined aL vsid Tight ©'' Leaked [] vsid vsid RP- vsid Leaked C Did not Open o Leaked o Repairs and Materials Used Test AR,er DC- Closed Closed Tight O Opeaed at Opeaed at osid Repair Tight o osid osid RP sid The above is certified to be true. Firm Name , Gv, ' .-� - ; -� Certified Tests - Firm Address y � z• � Cent Tester No. Date Gauge # /i}�'? �lv�� Date last accuracy tested !!- !�! White - Customer's Copy Yellow -City Copy Pink - Testers Copy