2013_0613 (17)CHECK ONE:
IRRIGATION DOMESTIC FIRELINE
BACKYLOW PREVENTION ASS EMILY TEST AND MAINTENANCE REPORT
NAND OF PWS: CITY OF COPPELL
PWS I.D. 4
LOCATION OF SERVICE'
The r. it prevention assembly detailed below has been tested and maintained as required by '111RCC
regulations and is certified to be operating within acceptable parameters.
Serial Number
fill !3
Double Check Valve Assembly
DC-Closed
Closed Tight
Opened at
Opened at
Tight 3
Leaked
sid
RPpsid
Leaked
Did not en
Op
C3
Repairs
and
Matefials
Used
DC-Closed
Tight
RP --j)sid
The above is certified to be true.
FirmName-/�,-,' /L'4L-
CertifiedTester.'�""'?"/
I ry,
-7
Firm Address I'lL P"',� / / �' Cat Tester No. P Date
Gauge '// /' '?C
Date last accuracy tested /,,7
White - Customer's Copy Yellow - City Copy Pink - 'f'ester's Copy