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2012_0612 (6)
CHECK ONE: IRRIGATION DOMESTIC FIRELINE / — BACKFI.OW PREVENTION ASSEMBLY TEST AND CE REPORT NAME OF PWS: PWS LD_ # CITY OF COPPELL LOCATION OF SERVICE: � l tia 6yl rYl prr� Tine bacldlow pieventian assembly detailed below' bas bem tested wad maintained as rogttired by TNRCC rey.,tAe;r,,,� wad is certified to be operating within acceptable para�rs_ TYPE OF ASSEMBLY c Reduced Pressaae Principio c Pmstac Vaciamm Brraloer Double Chock Valve o Amnosphere Vacmmm Brealaer Maaufacttarr �.(.� -�� Size �f� '� Modc3 Number 00 %j�l / Locatad At lV � �.C'.E b�Cc a �'r' Serial Nt�ber �%� ©% 2 The above is cAertified REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAlt�w Double Chiecic Valve Assembly Film Name H �iGY� �.c? f iL��_ Certified Testa i %/.! S�s-� �i S 7D�% Fam Address �� Est Chec3c 2nd Checlt Relief Valve Air Inlet CLeelc Valve Initial Test DC- Closed 2 . 3 Closed Tight j�- Opeacd at Opened at osid Tight � Leal-ed ❑ vsid osid �'-- -F's'd Lcai:ed ❑ Z � � Did ant Opoa ❑ Leaked ❑ �P� wad Mataiais Used Test After DC- Closed Closed Tight ❑ Opcoed at Oixmd at �sid Repair Tight ❑ nod °� RP The above is cAertified to be ttS7C_ Film Name H �iGY� �.c? f iL��_ Certified Testa i %/.! S�s-� �i S 7D�% Fam Address �� 7l/ � I.GL� Y4T f� LQ Cers. Testa Ne�?P�n /GAS% Date -- -5,�'� �L- Gauge # f�, / / CX��7 S Date Last accuracy tested Cf'�J/ White - Customer's Copy Yellow -City Copy Pink - Tea;ter`s Copy