2012_0828CIIECK ONE.
IRRIGATION DOMESTIC FIRELINE c/
BACKFi.OW PREVENTION ASSEMBLY TEST AND CE REPORT
NAME OF PWS. CITY OF COPPELL
PWS I.D_ #
LOCATION OF SERVICE: !/�� � � �� -� X357 �'i��... =v ��
The bac3cflow prevention assembly derailed below has bees testtd and maintained as t-eq�� by TNRCC
rz_QUlations and is certified to be operating within acceptable parameters_
TYPE OF ASSEMBLY
C Reduces Pressure Principle a Pressure Vacua**+ Breaker
�' DoubleChe /ck �Va�lve� O Atmosphere Vacuum Breaker
Maaufacnser !� ` �k�- -� Size w�� /� � p — , ' /
Model Number 9So X L- Located At Y`✓v -s��- �- /�
Serial Numbs L/Z3 � / �
The above is eatified to be true. , J
Firm Name *Q �•-� — �� �y'�'s Ceztified Tester �� H n �T�+ , �� �,��`�
Firm Address pv � �-� � � s 7 �^�O` -'r� Cat Testa No: ° � ®vim G /-� %Date � � � / <—
Gauge # r� �C�qo � �g
Date last accuracy tested � �' � ! � r z
White - Customer's Copy Yellow -City Copy Pink - Tester's Copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VACUUM BRFATrFjZ
Double Check Valve Assembly
Relief Valve
Air Inlet
Chec3c Valve
Ist Check Z, �p
2nd Checl: 3 • J
Initial Test
DC- Closed
Closed Tight.
Opined az
Opened at
nsid
Tieht
Leaked �
nsid
nsid
RP- nsid
�� p
Did not Open O
Leaked O
Repairs
and
Materials
Used
Test Agar
Repair
DC- Closed
Tight 0
Closed Tight o
Opened at
nsid
Opened at
vsid
nsid
RP sid
The above is eatified to be true. , J
Firm Name *Q �•-� — �� �y'�'s Ceztified Tester �� H n �T�+ , �� �,��`�
Firm Address pv � �-� � � s 7 �^�O` -'r� Cat Testa No: ° � ®vim G /-� %Date � � � / <—
Gauge # r� �C�qo � �g
Date last accuracy tested � �' � ! � r z
White - Customer's Copy Yellow -City Copy Pink - Tester's Copy