2013_1120CHECK ONE:
IRRIGATION DOMESTIC FIRELINE X
BACI(FLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS:
CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: (000 LL- AMOC i
The bad -Low prevention assembly detailed below has been tested and maintained as required by TNRCC
regulations and is carti5ai to be operating within acceptable parameters.
e Reduced Pressure Principle
Double Check Valve
Manufacturer /, 4 _ --
Model Number 7 74 1)(Q A
TYPE OF ASSEMBLY
C Pressure Vacuum Breaker
C Atmosphere Vacuum Breaker
Size O
Located At AIW Fine Vacs
Serial Number % ®1 / -7 0,350 I
14id A &�- eo f h P>s s
11 1 REDUCED PRESSURE PRINCIPLE ASSEMBLY I PRESSURE VACUUM BREAKER
Double Check Valve Assembly
1st Check 2nd Check Relief Valve 4ir Inlet Check Valve
Initial Test DC- Closed Closed Tight ❑ Opened at Opened at osid
Tight ❑ Leaked ❑ ��sid osid
RP -osid '�
Leaked ❑ Did not Open ❑ Leaked ❑
Reps
and
Materials
Used
Test After I DC- closed I Closed right ❑ Opened at Opened at
Repair Tight ❑ osid esid
RP osid
The above is certified to be true.
Firm Name &+ina �4,o- t0kcas
Firm Address i6 &< 747
Www oack w Tp-
Gauge # 06 llW75
Date last accuracy tested ,, j b 115
Certified Tester )I&IJ 447-01J
CerL Tester No. BPa0 KQ6 5) Date �d
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy