2013_1101CIIECK ONE: .,
IRRIGATION
DOMESTIC
FI1iRi_iN$
BACT�3.OW PREVENTION ASSE1t+IBLY T E_S'I' AND C� REPORT
NAME OF PWS_ CITY OF COPPELL
PWS LD- #t
LOCATION OF SERVICE: 1 Il 1.•L� • � -r "�- � i �` �,)
r��
The bar3�low prevention assembly detailed below has bem tested and maintained as required by TNRCC
rcgttlations arul is certified to be operating within acceptable parameters.
TYPE OF ASSEMBLY
e Reduced Pressure Principle c Pressure Vaartml Breaker _
r� Double Check valve Q Atmosphere Vacurun Breaks
Maaufacnaer !'" . �� � � Siu
Modei Number r � � Located At �� ; � <' ±-_'
�•. .;,`)
Serial Number � j- i 1 5 Cr 1%
The above is cetified to be trot_ r�
Firm Name i rte- '.� �>^ . ,: i p � • r ' °3�i ;:F-. ; g'CCR[fied Tester '• �� 4> l _ L s ' ` - > f : ti.`
Firm t;, < , "� > - - . �. r -
Addtzss � � - � P- �•: Cest Tests No. , -: i �. - � f 3 Dace i 1 - f - � �'�
j
Gaud' i� � ; - -i__ q � i -pt i in �i
Date Iasi accuracy tested � -_ �; - �
White - Customer's Copy Yellow -City Copy Pints - Tester's Copy
REDUCED PRESSURE PRINCIPLE SE1tiIBLY
PRESSURE VACUL7M BRFSTtFR
Double Chee3t Valve Assembly
1st Chec3c tad Cheri: Relief Valve
Air Inlet Cbeck Valve
Initial Test
DC- Closed Closed Tight ,"¢� Opened at
Opened at raid
Tight � Leaked 0 �nsii
osid
RP -d
Leaked o
Did not Opm a Leaked a
Repairs
and
Materials
Used
Test Altar
DC- Closed Closed Tight a Opined at
Opened at nsid
Repair
Tight O nsid
RP
The above is cetified to be trot_ r�
Firm Name i rte- '.� �>^ . ,: i p � • r ' °3�i ;:F-. ; g'CCR[fied Tester '• �� 4> l _ L s ' ` - > f : ti.`
Firm t;, < , "� > - - . �. r -
Addtzss � � - � P- �•: Cest Tests No. , -: i �. - � f 3 Dace i 1 - f - � �'�
j
Gaud' i� � ; - -i__ q � i -pt i in �i
Date Iasi accuracy tested � -_ �; - �
White - Customer's Copy Yellow -City Copy Pints - Tester's Copy