2013_0129 (4)CIIECK ONE:
IRRIGATION
DOMESTIC
FIRELINE ' f
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. # 72 7 C6,^ vol
LOCATION OF SERVICE: 511&� r,\
The bacldlow 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 uced Pressure Principle ❑ Pressure Vacuum Breaker
Double Check Valve ❑ Atmosphere Vacuum Breaker
Manufocturer w� ` Size
Model - Number 7,�
Serial Number 1J y 6�
Located At
The above is certified to be true.
Firm Name Certified Tester tom.- s1"rxJ Lam A�
14548 m C ja e. V. eLJ
Firm Address 15t. t�( Cert. Tester No.`s13�'4 / Date
Gauge # ()t-1 I I DC>J�,°t
Date last accuracy tested g'-S--/a
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VACUUM BREAKER
Double Check Valve Assembly
Relief Valve
Air Inlet
Check Valve
1st Check
2nd Check
Initial Test
`_
sh
j�
DC- Closed
Tight 7. Z Y
RP- _psid
Leaked ❑
06sed Tight Y
Leaked ❑
Z 'g
Opened at
osid
Opened at
osid
Did not Open ❑
osid
Leaked ❑
Reps
and
Materials
Used
Test After
Repair
DC- Closed
Tight ❑
Closed Tight ❑
Opened at
osid
Opened at
osid
______p sid
RP sid
The above is certified to be true.
Firm Name Certified Tester tom.- s1"rxJ Lam A�
14548 m C ja e. V. eLJ
Firm Address 15t. t�( Cert. Tester No.`s13�'4 / Date
Gauge # ()t-1 I I DC>J�,°t
Date last accuracy tested g'-S--/a
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy