2012_0612 (7)CIIIiCK ONE:
I$RIGATION�_ DOMESTIC
FIR.ELIN
BACI�3.,OW PREVENTION 1►SSEIVIBLY TEST' AND CE REPORT
NAME OF PWS:
CITY OF COPPELL
PWS LD_ #
LOCATION OF SERVICE_ DL} � ��Q 6'VI �1/LO �'l
The baci-flow ptzveation assembly detailod below bas berg tested and mainaaitbad as Wired by TNRCC
re_�tlations and is cetified to be operating within acceptable paratt�rs_
TYPE OF ASSEMBLY
� Reduced Pressta+c Principle C Pressare Vacuum Breaker
Doublc Check Valvc o Atmosphere Vacenmm Breaker
Manatfaetttrer �(/ Qe �--•� Size � r r
Model Number �7 /LL � Located As ��� �C�/l w1F kLQ��7y�
Serial Numbs ��+ ��
white - customer's copy Yellow -City CapY Pink - TeaRer's Copy
REDUCED PRESSURE PRINCIPLE ASSE1bIBLY
PRESSURE VACUUM BREAKER
Double Chiec3c Valve Assembly
1st CbecJc
2nd Cheek
Relief Valve
Air Inlet
Clreeic Valve
Initial Tess
DC- Closed 2-,�
Closed Tight �'�
Opened ai
Opeaod at
t�sid
Tigbt
t �t-� o
vsid
osid
Rp- nsid
I.ral:cd o
2 -`-�
Did not Open o
L.eaiced �
Repairs
and
Materials
L7sed
Test ASa
DC- Closed
Closed Tight o
Opened as
Opened at
�sid
Repair
Tight �
nsid
osid
RP
The above is ceraSad to be trite.
!,
Firm Name �c�2in � � 7�C� S CetiSed Testa ,.(, � SCE l -i-r � �t"O � ;
Firm w�� k; '7 (iL�x4 �.e�t Lr � Cert. Testa No. "�Y7 /OG.�S' f Date __(z f�Z
-TX
Gauge # �j(��l C>n� S
Dgte Iast a��ura�y tested � ,S � / �
white - customer's copy Yellow -City CapY Pink - TeaRer's Copy