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2013_0411 (13)CHECK ONE: IRRIGATION DOMESTIC FIRELINE BACIULOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: PWS I.D. # CITY OF COPPELL c� LOCATION OF SERVICE: C3I�G � �-�/ � Hp�-, � tCC.ri- �,>14 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 C Reduced Pressure Principle ❑ Pressure Vacuum Breaker ❑ Double Check Valve ❑ Atmosphere Vacuum Breaker Manufacturer FF 46 Size / Model Number 8 ©S r` Located At Fj,PE /� IL eck goer Serial Number ka k.3 95 j The above is certified to be true. Firm Name OfW F, A E Firm Address 29N Gauge # S Date last accuracy tested -7/1 � / i j Certified Testa m C�aE 1 W (E, rj Cat. Testa No.�� % Date I 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 nsid � �� Tight l , (o t�1 RP- psid Leaked C3 nsid nsid Leaked ❑ Did not Open ❑ Leaked ❑ Reps and Materials Used Test After DC- Closed Closed Tight ❑ Opened at Opened at nsid Repair Tight ❑ psid nsid RP sid The above is certified to be true. Firm Name OfW F, A E Firm Address 29N Gauge # S Date last accuracy tested -7/1 � / i j Certified Testa m C�aE 1 W (E, rj Cat. Testa No.�� % Date I White - Customer's Copy Yellow - City Copy Pink - Tester's Copy