2012_0828 (3)CIIECK ONE.
IRRIGATION DOMESTIC FIRELINE L'/
BACKT'ZOW PREVEN'T'ION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS:
PWS I.D. #
CITY OF COPPE'LL
LOCATION OF SERVICE: L ��-� ��-- � �-� tc_. � I3�' T ��
The bacldlow pzzvmtion assembly detailed below has bem tested and ma;nra;ned ag required by TNRCC
rc_ettlariotts and is terrified to be operating within acceptable parameters.
TYPE OF ASSEMBLY
C Reduced Pmsure Principle C Pressure Va�-uu**+ Breaker
- � Double Check Valve � Atmosphere Vacuum Breaker
_ � „
Manufactazrer % - � Size
Model Number �o �� Located At /� � � c�� �� � °��
Serial Number 1� 3 3 3
The above is certified to be true..
Firm Name �1 �-- �R-� _�-uS Certified Tester �� �+.��.�'� �z'�� -�-
Firm Addrzss �� �_-;< -7 °/ 7 G`� "`'�- • Cert. Tests No.� T� o� � /-5 %Date 8J � 3' - / z—
Gauge # � 7 c3 �i �' L F88
Date last accuracy tested %- 3 �- � '�
Wtute - Customer's Copy Yellow -City Copy Pink - Tester's Copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VACUUM BRF'AT�R
Double Cher3c Valve Assembly
Relief Valve
Air Inlet
Cheek Valve
1st Cheek 2' �'
2nd Checl:3.
Initial Test
DC- Closed
Closed Tight
Opined at
Opined at
osid
Tight
Leaked o
osid
osid
RP- osid
t �LCd p
Did not Opm o
Leaked '�
Rcpatrs
and
Mata-ials
Used
Test After
DC- Closed
Closed Tight D
Opined at
Opeaed at
osid
Repair
Tight a
osid
osid
RP sid
The above is certified to be true..
Firm Name �1 �-- �R-� _�-uS Certified Tester �� �+.��.�'� �z'�� -�-
Firm Addrzss �� �_-;< -7 °/ 7 G`� "`'�- • Cert. Tests No.� T� o� � /-5 %Date 8J � 3' - / z—
Gauge # � 7 c3 �i �' L F88
Date last accuracy tested %- 3 �- � '�
Wtute - Customer's Copy Yellow -City Copy Pink - Tester's Copy