2012_0828 (2)CIIECK ONE.
IRRIGATION
DOMESTIC
FIRELINE
BACT�Z.OW PREVENTION ASSEMBLY TEST AND MA7NTENANCR REPORT
NAME OF PWS
CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: �'- -t�� -� ��^- ��- � -��- -- � !��' ! ��
The bacldlow prevention assembly detailed below has been tested and main a;ned as required by TNRCC
re_Qnlations and is cez-dfied to be operating within acceptable parameters_
TYPE OF ASSEMBLY
C Reduced Pressure Principle c Pressure Vacut**+± Breaker
�-- Double Check Valve � Atmosphere Vac *��**+ Breaker
c� "
Maaufacttaer �� _ Size �/ r
Model Number 35� � � Located At /�.�s � ---��- !/✓Z"` -��
Serial Number -� � �-� 9 �
The above is certified to be true. /j
Firm Name Ac- �- �..o=••, � +LSZ _� ` Certified Tester ��� ✓r- e--f'� - `��� -P�`�
Firm Address � v a a iG 7y 7 v���- �- Curt Tester No. � �' °'' ° �° �S 1 Dau �- z -� � �z�
Gauge # O 7 Dom/ o �{-� �
Date last accuracy tested %- 3 / - 1 '
White - Customer's Copy Yellow -City Copy Pink - Tester's Copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VACC7LTM BRE_a►�R
Doubie Cheek Valve Assembly
Relief Valve
Air Islet
Check Valve
1st Cheek -� �
2nd Checl: �, �
Initial Test
DC- Closed
Tight
Closed Tight
Leaked O
Opined at
osid
Opened at
osid
osid
RP- osid
I..eaked p
Did not Open L7
Leaked '�
�Pa;. -�
and
Matcriais
Used
Test Af%r
Repair
DC- Closed
Tight o
Closed Tight o
Opened at
osid
Opened at
osid
osid
RP sid
The above is certified to be true. /j
Firm Name Ac- �- �..o=••, � +LSZ _� ` Certified Tester ��� ✓r- e--f'� - `��� -P�`�
Firm Address � v a a iG 7y 7 v���- �- Curt Tester No. � �' °'' ° �° �S 1 Dau �- z -� � �z�
Gauge # O 7 Dom/ o �{-� �
Date last accuracy tested %- 3 / - 1 '
White - Customer's Copy Yellow -City Copy Pink - Tester's Copy