2013_0613 (16)IRRIGATION DOMESTIC FIRELINE x
BACKFLOW PREVENTION ASSEM33LY TEST AND MAINTENANCE REPORT
NAME OF PWS:
PWS I.D. 4
CITY OF C'OPPELL
LOCATION OF SERVICE:
4,/
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.
Serial Number '/ 16' / ,�
Tice above is `,+ ed to be true.
Firm Name Certified Tester
Firm Address 13 0 L 7 2 Z -L f'-I" Ccrt Testa No. 2 CL Dam
Gauge # '&-) 6 e '117
Date last accuracy tested <-/ - s,,' -/ "ir
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy