2013_1011 (2)CHECK ONE:
IRRIGATION
i
FIRELINE
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS:
PWS I.D. #
CITY OF COPPELL
LOCATION OF SERVICE:
The bac0ow prevention assembly detailed below has been tested and maintained as required by TNRCC
regulations and is certified to be operating within acceptable parametm.
o Reduced Pressure Principle
�( Double Chock Valve
Maaufacuaer F 6.8 CA-7
Model Number O o g_
Scrim Numbers
TYPE OF ASSEMBLY
❑ Pressure Vacuum Breaker
❑ Atmosphere Vacuum Breaker
�r
Size ,,.. //
Located At bU S lX, 0 S4
REDUCED PRESSURE PRINCIPLE ASSEMBLY 1 PRESSURE VACUUM BREAKER
Double Check Valve Assembly
1st Check Z . - tad Cbeck`2- 6 Relief Valve Air Inlet Check Valve
Initial Test DC- Closed Closed Tight Opened at Opened at id
Tight ter Leaked ❑ _p sid `� d
RP -____ psid
Lea;e D Did not Open D Leaked J
Repairs
and
Materials
Used
Repair fight DC-Closed o I Closed Tight ❑ I o� at I at
The above is certified to be true.
Fm Name A - rtA� CatiScd Tester
Firm Addr+esa Po 84- 7 9 Cent. Tester No. ` P020 615-7 Date / ' / 3
-)ry- 7Si�
Gauge # d ?y 9> 4 d'9
Date last accuracy tested 1.3
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy