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2012_0627 (5)
CHECK ONE: IRRIGATION 11116 ;r: FIRELINE X BACMOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE: The baekflow 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 a Pressure vacuum Breaker rik-1- Double Check Valve o Atmosphere Vacuum Breaker Manufacturer Size - Model Number U� (� Located At i h e 1�, ice. iVa v Serial Number Z O Z The above is certified to be true. Firm Name Certified Testa 7y4 vti• �.� C (�� ,.,,, Firm Address P 0 1 p '� wW" i£ert. Testa No. _LLL.sLr ri' i vi 6 Gauge g () � 11-1- `b G z Date last accuracy tested Z 2- White - Customer's Copy Yeuow - City Copy Pink - Tester's Copy REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER Double Check Valve Assembly 1st Check tad Check Relief Valve Air Inlet Check Valve Initial Test DC- Closed Tight 1 i `{ Closed Tight Leaked o Opened at sid Opened at �nsia ___--ps id RP -,_ nstd ked Lea o / ` �P Did not Open D Lea ked o Repairs and Materials Used Test A8a Reps DC- Closed Tight a Closed Tight © Opened at __p sid Opened at - sid _*d The above is certified to be true. Firm Name Certified Testa 7y4 vti• �.� C (�� ,.,,, Firm Address P 0 1 p '� wW" i£ert. Testa No. _LLL.sLr ri' i vi 6 Gauge g () � 11-1- `b G z Date last accuracy tested Z 2- White - Customer's Copy Yeuow - City Copy Pink - Tester's Copy