2012_0511 (2)CHECK ONE:
IRRIGATION
i • Di: 111 V e
FIRELINE Y
BACKCFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. # D u Y-Q Ve a Wes_
LOCATION OF SERVICE: (an { Q JCA I LN3
The backdlow 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
Double Check Valve ❑ Atmosphere Vacuum Breaker
Manufacturer ti.Qyaf Size jr
Model Number D L -h A Located At y a u l,�
Serial Number 0001-754,
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER
Double Check Valve Assembly
1st Check 2nd Check Relief Valve Air Inlet Check Valve
Initial Tess DC- Closed Closed Tight g Opened at Opened at __p sid
Ti & Leaked ❑ esid —paid
RP. 3.... , 0-psid
Leaked ❑ Did not Open ❑ Leaked ❑
Reps
and
Materials
Used
Test A ter DC- Closed Closed Tight ❑ Opened at Opened at d
Reps Tight ❑ ysid ,_- --psid
RP
The above is certified to be true.
Firm Name Ac 4-t ti f- i F r" PioS Certified Tester J610 'k 'ro r3
Firm Address )Q 2 &y 7e-7-7 W axe �oChw Cat Testa No. 66,wib6 ll Date 2
,TX
Gauge # fXo f f Di' )75
Date last accuracy tested
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy