2013_1011 (6)CHECK ONE:
IRRIGATION
DOMESTIC
FIRELINE '�
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. # /
LOCATION OF SERVICE:
The backflow prevention assembly detailed below has been tested and maintained as mgwred by TNRCC
regulations and is certified to be operating wi* accept able pis.
❑C Reduced Pressure Principle
jk Double Check Valve
ManufactuM zlj4e'
Model Number o o l i-i i dT
Serial Number Shy r
TYPE OF ASSEMBLY
• Pressure Vacanan Breaker
• Atmosphere Vacuum Breaker
Size
Located At S 4C. ►' `�'``'r'
REDUCED PRESSURE PR NCIPLE ASSEMBLY PRESSURE VACUUM BREAKER
Double: Check Valve Aswml ly
1st Check %'. tad Che k f• Rem Valve Air Inlet Che:dc Valve
Initial Test DC- Closed Closed T ght Opened at Opened at � id
Tight Leaked o �osid _--psi
RP- _--,.psid
Leaked O Did not Open O Leaked 0
Repairs
and
Matesials
Used
Test After I DC- Closed Close
Repair Tight C3
RP------=W
The above is certified to be, -true.
Firm Name A ems'^- t'r xk-
Firm A&hu Po S V- 79
Gauge #
Date last accuracy tested 6 / /- 13
o j Opened at I Opened at I �psid
I -. id __.._,psid
C rdited Tester i'� ✓t .
Cart. Tester No. 810060 Date /.
White - Customer's Copy Yellow - City Copy Pink Tester's Copy