2013_0812 (2)CHECK ONE:
IRRIGATION DOMESTIC FIRELINE V"
BACKFLOW PREVENTION ASSEMBLY TEST AND MAU TI iANCE REPORT
NAME OF PWS:
PWS I.D. #
CITY OF COPPELL
LOCATION OF SERVICE:
The baciflow prevention assembly detailed below has been tested and maintained as required by TNRCC
regeuladom; and is certified to be opazung witbm acceptable parameters.
C Reduced Pressure Principle
Double Check Valve
Manufacturer
Model Numuber 3rd Dl
Serial Number '3'2-7"?
TYPE OF ASSEMBLY
e Pressure Vacuum $realer
o Atmosphere Vacuum Breaker
Size
Located At
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM B
Double Check Valve Assembly
1st Check Z' ? 2nd Cheek 3- & Relief Valve Air Inlet Check Valve
Initial Test DC- Closed Closed Tight Z Opened at Opened at _—jos id
Tight 1 ealked O --psid d
Leaked p Did not Open o Looked
Reps
and
Materials
Used
The above is certified to be true.
Firm Name A - Lae— PAS Certified Tester KI -) 2 K e' c•+P
Firm t —O -? r-I- Cat Tester Nola Pz:0" /s'7 Date
pc/a4, -r *. -75le- T
Gauge # 07 z> 9 o-4 9'3
Date last accuracy tested 6-0-I's
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy