The URL can be used to link to this page

2013_0528 (2)CHECK ONE: IRRIGATION DOMESTIC FIRELINE BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE: F2FF Por7 Qk" 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 ❑ Pressure Vacuum Breaker ❑ Double Check Valve C7 Atmosphere Vacuum Breaker Manufacturer WA —1r5 Size 8 Model Number I cl & y Located At V Ay`' Serial Number 110? 3S - 02o-?' The above is certified to be true. yes Firm Name LL ''`S Fi 2 F 6u,1`0 Certified Tester N, r,--1 S 6c" 10265 mice r" " Firm Address I)AiiZ r Tx '7s'23 S Cent Testa No. a©d Date Gauge # or111196 Date last accuracy tested /--7-/3 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 ❑ Opened at Opened at osid Tight ❑ RP- Z 1 Dsid Leaked ❑ osid osid Leaked ❑ Did not Open ❑ Leaked ❑ Reps and Materials Used Test After DC- Closed Closed Tight ❑ Opened at Opened at osid Repair Tight ❑ nsid osid RP sid The above is certified to be true. yes Firm Name LL ''`S Fi 2 F 6u,1`0 Certified Tester N, r,--1 S 6c" 10265 mice r" " Firm Address I)AiiZ r Tx '7s'23 S Cent Testa No. a©d Date Gauge # or111196 Date last accuracy tested /--7-/3 White - Customer's Copy Yellow - City Copy Pink - Tester's Copy