2013_0812 (3)CHECK ONE:
IRRIGATION DOMESTIC FIRELINE
BACIOFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE:
ila 914
The bac tiow prevention assembly deudW below has ban tested and maintained as regwred by TNRCC
regulations and is certified to be opera vvitbna acceptable parameters.
TYPE OF ASSEMBLY
C RedzCad Pressure Principle a Pressure Vacenrm Brea1w
u-a Double Greek Valve C Atmosphere Vacutsm Breai=
Manufacturer F-a,, ' Size Jr
Model Number 'FO L, Located At .�
Serial Number 5 3 3 3 �_
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER
Double Check Valve Assembly
1st Check Z ' tad Check 3.4/ Relief Valve Air Inlet Check Val"
Initial Teat DC- Closed Closed Tight Opened at Opened at _P aid
Tight af, Lea W- o d nsid
Lealwdd o Did not Open o Leaked o
Repairs
ad
Materials
Used
The above is certified to be true,
Fnm Name ACL,,- - Lots- Certified Tester Kam--f° e"O
Firm o !3a`f- -? Cent. Tester No.SLe=6 /11 Date t
(A/ , -r*. -7t5-/4-?
Gauge # r77D%v-y-8'8
Date last accuracy tested
White - Customer's Copy Yel%w - City Copy Pink - Tester's Copy