2013_1011 (3)CHECK ONE:
IRRIGATION
1 SIT t
FIRELINE t--'
BAC 0LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE:
The bacidlow prevention assembly detailed below has been tested and maintained as required by TNRCC
regulations and is certified to be operating within acceptable parameter.
TYPE OF ASSEMBLY
C , Reduced Pressure Principle a Pressure Vacmna Breaker
yzi Double Check Valve ❑ Atmosphere Vacuum Breaker
'�
Manufacuars td 3 Size %
Model Number Cad 2v+t22 Located At Ni F .
Serial Number ?1'19*
White - Customers Copy Yellow - City Copy Pink - Testers Copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VACUUM BREAKER
Double Check Valve Assembly
Refief valve
Air Inlet
Check Valve
1st Check 1.
2nd Check /.
Initial Test
DC- Closed
Closed Tight +4tr
Opened at
Opened at
id
Tight
Leaked D
.� sid
d
RP- _,_ -psid
I„ e� D
Did not Open D
Leaked D
Repairs
and
Lmataials
DC- Cl osed
Closed Tight D
Opened at
Opened at
Sid
Tight D
nsid
,____p aid
R,P
The above is certified to be true.
j
Firm Name Certified Tester .• rt PAL
Firm Address Po 8 i*1- Cert. Tester No. SPv-&o 61 S"j Date /_ f 3
7'r-- "7S1, 9
Gauge # d ? cs 9b 4 d?$
Date last accuracy tested 3
White - Customers Copy Yellow - City Copy Pink - Testers Copy