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2013_0122 (3)
i CHECK ONE: IRRIGATION DOMESTIC FIR.ELINE t BAC PLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL LOCATION OF SERVICE: /0 026Z,� The backflow prevention assembly detailed below has been tested and maintained as required by TNRCC regulations and is certified to be operating within acceptable parameters. e Reduced Pressure Principle Double Check Valve P Manufacturer Model Number 0 ©� Serial Number CJ 0 P TYPE OF ASSEMBLY e Pressure Vacuum Breaker o Atmosphere Vacuum Breaker t� Size Located At The above is certified to be true. 1. ..11. iii ,..u_•rl /. � /.�_ Cent. Tester NoM D M 713 Date - a:5 - a o/ 3 Gauge�37a3 Date last accuiiacy tested White - Customer's Copy Yellow - City Copy Pink - Tester's Copy REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1st Check 2nd Check Initial est \ R DC- Closed k ight �sid ;ad Closed Tight Leaked o Opened at �sid Opened at _psid Did not Open o --ps id Leaked O Rep Materials Used Test After Repair DC- Closed Tight o RP sid Closed Tight o Opened at esid Opened at �osid ____-p sid The above is certified to be true. 1. ..11. iii ,..u_•rl /. � /.�_ Cent. Tester NoM D M 713 Date - a:5 - a o/ 3 Gauge�37a3 Date last accuiiacy tested White - Customer's Copy Yellow - City Copy Pink - Tester's Copy