Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
2012_0117 (18)
CIIECK ONE. IRRIGATION DOMESTIC FIRELINE BACKFi.OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I_D. # LOCATION OF SERVICE: � � /+ �: � -- . /-� � :7.; ��. The bacictlow pttvmtioa assembly detailed below has bem tested and maintained as required by TNRCC rcgttlations and is certified to be operating within acceptable parameters_ TYPE OF ASSEMBLY C Rcduccd Pressure Principle C Pressuzc Vacuttm Breaker Double Check Valve � Atmosphere Vacuum Breaker Manufacturer Sizc -- Model Number Serial Ntanber Located At __ '�`" The above is certified to be true. Firm Name Firm Address Gauge # Date last accuracy tested Cetifiod Tests . Cent Testa No. Date Wtute - Customer's Copy Yellow -City Copy Pink - Testers Copy REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BRF'A►T�'R Double Check Valve Assembly 1st Check 2nd Checl: Relief Valve Air Inlet Check Valve Initial Test DC- Closed Tight o Closed Tight © Leaked 0 Opened at Dsid Opined at osid osid RP- osid Leaked p Did not Opm o Leaked � �P�� and Materials Used Test ASer Repair DC- Closed Tight � Closed Tight o Opined at vsid Opened at osid osid RP sid The above is certified to be true. Firm Name Firm Address Gauge # Date last accuracy tested Cetifiod Tests . Cent Testa No. Date Wtute - Customer's Copy Yellow -City Copy Pink - Testers Copy