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2013_1120 (4)
CHECK ONE: IRRIGATION DOMESTIC FIRELINE BACKFLOW PREVENTION ASSEMBLY TEST AND XAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE: The bacldlow prevention assembly detailed below has been tested and =iatained as required by TNRCC regulations and is certified to be operating within acceptable parameters. C Reduced Pressure Principle Double Check Valve Manufacturer (&4. i Model Number Q OZ�2 l Serial Number 16 5 5 TYPE OF ASSEMBLY C Pressure Vacuum Breaker C Atmosphere Vacs Breaker J size Located At Sal LOi''A-e-Y Lo- REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER S Double Check Valve Assembly 1st Check 2nd Check Relief Valve Aar Inlet Check Valve Initial Test DC- Closed Closed Tight )Z�- Opened at Opened at --p id Tight t - (o )4- Leaked o osid _--„�nsid RP- __.psid 2 Leaked C Did not Open O Leaked C Reps and Materials Used I Test A8a 1 DC-Closed Q Closed Tight C 1 at Owed at I --j'sid The above is certified to be true. Firm Name A1 zko vi C3 re- Pko : Firm Address q�_� Di}cGc �laC Gauge # Q 11 a©75 Date last accuracy tested 4 Citified Tester 11;60 I -LO IJ Cert. Testa No. �,3PQ0D 6S i Date jkj1-jQZ13 White - Customer's Copy Yellow - City Copy Pink - Tester's Copy