2012_0117 (27)..- a ¢ �'
CIIECK ONE=
IRRIGATION DOMESTIC FIRELINE - "
BACKFT.OW PREVENTION ASSEMBLY 'PEST AND MAINTENANCE REPORT
NAME OF Pws: CITY OF COPPELL
PWS I.D- #
LOCATION OF SERVICE: --�. /%IAcNK % %1 �/�'
The bacictlow prevention assembly detailed below has been tested and ma;nrained as rcq�d by TNRCC
regttiations and is ca-tified to be operating within acceptable paramctas_
TYPE OF ASSEMBLY
e _ Reduced Pressure Principle a Pressure Vactn -�**+ Breaker
m Doubic Chccic Valve � Atmosphere Vacuum Bteaka
Maaufacturer �:<_ ;- � Size � �2
Modei Ivttmber - �1 Located At jS / ��, � .�
Scrim Number
J
The above is certified to be true.
Fitm Name Cetificd Testa -
Firm Address �N��A� Cat. Testa No. ''- _ Date _ . -.. -
Gauge # -
Date Iast accuracy tested �� —'�'��
Wtute - Customer's Copy Yellow -City- Copy Pink - Tester's Copy
REDUCED PRESSiJRE PRINCIPLE ASSEMBLY
PRESSURE VACUUM BRF'A�R
Double Check Valve Assembly
1st Check
tad Checl:
Relief Valve
Air Inlet
Check Valve
Initial Test
DC- Closed t`
TiehL e5
Closed Tight Q
Leaked o
Opined at
nsid
Opined at
nsid
nsid
RP -�psid
I.ealced a
_ _ �
Did not Opm o
Leaked �
�P��
and
Materials
Used
Test After
DC- Closed
Closed Tight o
Opined at
Opined at
nsid
Repair
Tight o
nsid
nsid
RP sid
The above is certified to be true.
Fitm Name Cetificd Testa -
Firm Address �N��A� Cat. Testa No. ''- _ Date _ . -.. -
Gauge # -
Date Iast accuracy tested �� —'�'��
Wtute - Customer's Copy Yellow -City- Copy Pink - Tester's Copy