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2012_0724 (7)CHECK ONE: IRRIGATION DOMESTIC FIRELINE BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. LOCATION OF SERVICE: Z� ©� 24 b () L' EeA IA The baclflow prevention assembly detailed below has been tested and maintained as required by TNRCC rcguiations and is certified to be operating within acceptable parameters. Reduced Pressure Pressure Principle Double Check Valve Manufacturer Model Number Serial Number =� TYPE OF ASSEMBLY C Pressure Vacuum Breaker D Atmosphere Vacuum Breaker Size 314 Located At 2' ItA of IeP �WAk-- 44-m-4 c&,Lf The above is certified to be true. Ftrm Name NS Certified Tester a V Y i Firm Address �1 � Cert. Tester No. P 10(0 Date Gauge # o R ob6 f A Date last accuracy tested S— 2-0 l Z White - Customer's Copy Yellow - City Copy Pink - Tester's Copy REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER Double Check Valve Assembly ist Check eck 2n��- Relief Valve Air Inlet Check Valve Initial Test DC- Closed Tight 4 RP- � ' psid Closed Tight Leaked O C3 2-' Opened at nsid Opened at nsid nsid Leaked ❑ Did not Open ❑ Leaked ❑ Reps and Materials Used Test After Repair DC- Closed Tight ❑ Closed Tight C Opened at vsid Opened at nsid _nsid RP sid The above is certified to be true. Ftrm Name NS Certified Tester a V Y i Firm Address �1 � Cert. Tester No. P 10(0 Date Gauge # o R ob6 f A Date last accuracy tested S— 2-0 l Z White - Customer's Copy Yellow - City Copy Pink - Tester's Copy