2012_0511 (3)CHECK ONE:
IRRIGATION
DOMESTIC x FIRELINE
BA00WW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. # Qyue PJ04
7
LOCATION OF SERVICE: too L y
The backnow 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
34 Double Check Valve o Atmosphere Vacuum Breaker
Manufacturer fe g L o Size z it
Model Number 860 Located At Au -I-e.-r
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER
Doable Check Valve Assembly
1st Check 2nd Check Relief Valve Air Inlet Check Valve
Initial Test DC- Closed Closed Tight Opened at Opened at � id
Tight JY Leaked ❑ _ osid sid
RP- 2 ,D vsid
LusedLeaked ❑ Did not Open D ked Lea O
DC- Closed Closed Tig ht ❑ Opened at Opened at _� d Tight ❑ d osid
RP
The above is Acetified to be tau. ' f
Firm Name � , oN r—[ n..0 %'no< Cartifed Tester da o e; Hv STgN
F'um Address /'00 r5ox -7g7 W a xn V�a,.c tiu y Ceti Testa No. J;PQQ 1 CYo 4) Date 5/(/
Z
TX
Gauge # 0&11007-5
Date last accuracy tested q
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy