Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
2013_0822 (2)
CHECK ONE: IRRIGATION DOMESTIC FIRELINE BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: PWS I.D. # CITY OF COPPELL LOCATION OF SERVICE: 400 S; Free,ai - -( fkw� The bad - low 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 ❑ Pressure Vacuum Breaker Double Check Valve ❑ Atmosphere /Vacuum Breaker Manufacturer 141�ftS Size /f Model Number o -7 X13 Located At lthderar -,9 „L, U©m /14;11 Serial Number Z D/ 0 5 7 The above is certified to be true. Firm Namedin er i't1i d t • Ser_r Certified Tester Il o 4S-- /c/i 1%r- Firm Address Goo S, Oe Cvs L-5a — Gauge # O":U`I 1752- Date last accuracy tested /Z / Z —/Z Cent. Testa No. Date -2- Z —/,? White - Customer's Copy Yellow - City Copy Pink - Tester's Copy REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER Double Check Valve Assembly 1st Check 2nd Check Relief Valve Air Inlet Check Valve Initial Test DC- Closed Closed Tight F Opened at Opened at usid i -P-0 p4-5e,.- Tight ;f, RP- 3_Z psid Lea;ed ❑ Leaked 3 $ O usid usid Did not Open ❑ Leaked ❑ Repairs and Materials Used Test After DC- Closed Closed Tight ❑ Opened at Opened at sid Repair Tight ❑ psid usid RP sid The above is certified to be true. Firm Namedin er i't1i d t • Ser_r Certified Tester Il o 4S-- /c/i 1%r- Firm Address Goo S, Oe Cvs L-5a — Gauge # O":U`I 1752- Date last accuracy tested /Z / Z —/Z Cent. Testa No. Date -2- Z —/,? White - Customer's Copy Yellow - City Copy Pink - Tester's Copy