The URL can be used to link to this page

2013_0822CHECK ONE: IRRIGATION DOMESTIC FIRELINE BACKI!'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: PWS I.D. # CITY OF COPPELL LOCATION OF SERVICE: Y00 S. Ere e part �� v The back-flow 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 Reduced Pressure Principle a Pressure Vacuum Breaker ❑ Double Check Valve ❑ Atmosphere Vacuum Breaker Manufacturer W.-r-10 (- f5° Size / f/Z Model Number ©0% 612 -CST Located At Th Salle 91 `S'to Y & a.y% Serial Number /i 6 gjC 6 S The above is certified to be true. Firm Name ern er I Crr ,,y 4aZA ee,- Certified Tester 7 •1..€{ r Firm Address Goo 5 - ne- Cosr- oe Gauge # l270 ,P / 7 52- Date last accuracy tested /2- i L /Z Cert. Testy No. Date F -LZ /s' White - Customer's Copy Yellow - City Copy Pink - Tester's Copy REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER Double Check Valve Assembly lst Check 2nd Check Relief Valve Air Inlet Check Valve Initial Test S -7-2-13 Pt, 5 5e ,1 DC- Closed Tight RP- 7.6 Dsid Leaked o Closed Tight )4 Leaked ❑ 7.2 Opened at l nsid Opened at nsid Did not Open a Dsid Leaked o Reps and Materials Used Test After DC- Closed Closed Tight o Opened at Opened at p sid Repair Tight ❑ Dsid �osid RP sid The above is certified to be true. Firm Name ern er I Crr ,,y 4aZA ee,- Certified Tester 7 •1..€{ r Firm Address Goo 5 - ne- Cosr- oe Gauge # l270 ,P / 7 52- Date last accuracy tested /2- i L /Z Cert. Testy No. Date F -LZ /s' White - Customer's Copy Yellow - City Copy Pink - Tester's Copy