2013_1120 (5)CHECK ONE:
IRRIGATION DOMESTIC FIRELINE
BACULOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: C' 60 fir- -,rig
The backflow 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
C Reduced Pressure Principle C Pressure Vacuum Breaker
X Double Check Valve C Ataaosphere Vacm nn Breaker
Manufacturer 04,5 Size , 314 r
Model Number 06 7 M 1 Located At 1 J w F'l ✓'-e- Vat, %
Serial Number q6'7-77--
The above is testified to be true.
Firm Name &h0W-r1r-P- P2vs
Firm Address -711
ak"a hoc - k w Tx
Gauge # 06//0075
Date last accuracy tested q25ZI,3
Certified Tester tk6kt X70' tJ
Cart. Tester No. $% 1®621 Date I 1 -3
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VACUUM BREAKER
cc
u
Double Check Valve Assembly
1st Check
tad Check:
j
Relief Valve
Air Inlet
Check Valve
Initial Test
DC- Closed
Tight 2.2 -t
RP- _„�psid
Leaked p
Closed Tight g
Leaked 2 o
Opened at
nsid
Opened at
id
Did not Open C
____psid
Leaked C
Reps
and
Materials
Used
Test After
Repair
DC- Closed
Tight o
Closed Tight o
Opened at
p sid
Opened at
sid
_,.. _ psid
RP sid
The above is testified to be true.
Firm Name &h0W-r1r-P- P2vs
Firm Address -711
ak"a hoc - k w Tx
Gauge # 06//0075
Date last accuracy tested q25ZI,3
Certified Tester tk6kt X70' tJ
Cart. Tester No. $% 1®621 Date I 1 -3
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy