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2013_0812 (5)CHECK ONE: IRRIGATION DOMESTIC FIRELiNE it BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: PWS I.D. # CITY OF COPPELL LOCATION OF SERVICE: The back(low prevention assembly detailed below has been tested and maintained as required by TNRCC regulations and is certified to be operating within acceptable parameters. C Reduced Pressure Principle Double Check Valve Manufacnaa F -t.l�� Model Number ?06 Serial Number g 33 12- TYPE OF ASSE)tiMLY C Pressure Vacuum Breaker © Atmosphere Vacuum Breaker p mm Size d Located At z-,qS-� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER Doable Check Valve Assembly 1st Check Z.' `I tad Check 3 q Relief Valve Air Inlet Check Valve initial Test DC- Closed losed Tight Opened at Opened at _— sid Tight Leaked D nsid - id Leaked � o Did not Open o Leaked O Repairs and Materials Used Test Atka DC- Closed Closed Tight o Opened at Opened at _—psid Repair Tight ❑ _*d --jo sid RP The above is certified to be true. Firm Name ACS �-- Fire e�S CatiEW Testa --elk '' Firm -? ci? Cent. Tester NA �° ' b /s'� Date y44. -r *. -7ti48 Gauge # 07v9d-488 Date last accuracy tested White - Customer's Copy Yellow - City Copy Pink - Tester's Copy