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2013_0122 (2)CHECK ONE: IRRIGATION DOMESTIC FIRELINE X BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: PWS I.D. # CITY OF COPPELL LOCATION OF SERVICE: Idea 7 The bacltilow 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 W Double Check Valve ❑ Atmosphere Vacuum Breaker 1 �r Manufacturer ° Size Model Number (�' Located At r-- Serial Number ) 3 The above `is certified to be true. Firm Name7/ Certified Tester as ©s ,/ . C � '90/'3 Firm Address e/ Cert. Tester NoZ60 f O 77,3 Date Gauge #,, 3 7 2 3 53 Date last accuracy tested /- 2 2 - a2 6) / 6 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 lcdnal Test' DC- Closed Closed Tight Opened at Opened at osid Tight ❑ Leaked ❑ vsid osid C RP-. psid - Leaked �; Did not Open ❑ Leaked ❑ airs and Materials Used Test After DC- Closed Closed Tight o Opened at Opened at osid Repair Tight ❑ vsid osid RP sid The above `is certified to be true. Firm Name7/ Certified Tester as ©s ,/ . C � '90/'3 Firm Address e/ Cert. Tester NoZ60 f O 77,3 Date Gauge #,, 3 7 2 3 53 Date last accuracy tested /- 2 2 - a2 6) / 6 White - Customer's Copy Yellow - City Copy Pink - Tester's Copy