2013_1120 (3)CHECK ONE:
IRRIGATION
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FIRELINE
BACKFLOW PREVENTION ASSEMBLY TEST AND 11![AINTENANCE REPORT
NAME OF PWS:
CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE:Y -D�"
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
e Reduced Pressure Principle ❑ Pressure Vacuum Breaker
Double Check Valve G Atmosphere Yacuum Breaker
Manufacturer uh�s Size
2
Model Number 0. a Z Ll Located At Cc�IVKE'�' �LLei'Y
Serial Number 1,5332
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER
Pa SS Double Check Valve Assembly
ist Check 2nd Check Relief Valve Air Inlet Check Valve
Initial Test DC- Closed Closed Tight Opened at Opened at � d
Tight j • & � Leaked 8 0 �_,psid `-._ nsid
RP -,_ .psid
Leak-ad p Did not Open o Leal al
Repairs
and
Materials
Used
Test After DC- Closed Closed Tight o Opened at Opened at nsid
Repair Tight o osid �osid
RP std
The above is certified to be true.
Firm Address A&Y 79-7 - Cat. Tester No.F—Flx') QG5 t Date .� Z0jj3
z*a ha C kt ta-
Gauge # d (0 //D()7 j
Date last accuracy tested
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy