2012_0117 (26)CIIECK ONE.
IRRIGATION
DOMESTIC
„� �,
FIRELINE N "
BACIC%Z.OW PREVENTION ASSEMBLY TEST AND MAIl�TTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: � %�� �. f�)��,�,t%�%iHK
The bacicflow prevention assembly detailed below has been tested and maintained as required by TNRCC
regulations and is certified to be operating within acceptable parameters_
TYPE OF ASSEMBLY
C Reduced Pressure Principle C Pressure Vacutnn Breaker
_^-. Double Check Valve o Atmosphere Vacuum Breaker
Manufacturer - = tom. � -- �_ -' _ Sizc ;'. - --
Modes I�iumber � � ,r, Located At �_> i : � c : _� `r
Serial Number % �
The above is certified to be true.
Firm Name - ~ , � r: c Cei.ed Tester _- -
Firm Address ;% Cent. Tester No.. Date :� _. -� - = _
Gauge # ' � lE.- � r>>
Date bast accuracy tested ; ;� _ ; � � -- ,: ,
White - Customer's Copy Yellow -City Copy Pink - Testers Copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VACUCTM BRFasrF'R
Double Check Valve Assembly
1st Cheri:
2nd Chee3:
Relief Valve
Air Inlet
Cheek Valve
Initial Test
DC- Closed
Closed Tight o
Opened at
Opined at
vsid
Tight � ' - �!
Leaked �
vsid
vsid
RP- vsid
��;� p
Did not Open o
Leaked �
Repairs
and
Mata-ials
Used
Test After
Repair
DC- Closed
Tight o
Closed Tight a
Opined at
vsid
Opened at
vsid
vsid
RP sid
The above is certified to be true.
Firm Name - ~ , � r: c Cei.ed Tester _- -
Firm Address ;% Cent. Tester No.. Date :� _. -� - = _
Gauge # ' � lE.- � r>>
Date bast accuracy tested ; ;� _ ; � � -- ,: ,
White - Customer's Copy Yellow -City Copy Pink - Testers Copy