2013_1125 (2)CHECK ONE:
IRRIGATION
DOMESTIC
FIRELINE
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS:
PWS I.D. #
CITY OF COPPELL
LOCATION OF SERVICE:
N4 t"j ,
I/
The bac.Wow prevention assembly detailed below has been tested and maintained as required by TNRCC
regulations and is certified to be operating within acceptable parameters.
�s
Mamifacum
Reduced Pressure Principle
Double Check Valve
Model Number FP Y
Serial Number F U 0 U 1
TYPE OF ASSEMBLY
e Pressure Vacuum Breaker
o Atmosphere
size Atmosphere here Vacuum Breaker
'/ 4"
Located At .V• )AI `',,�V
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REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VACUUM BREAKER
Double Check Valve Assembly
Relief Valve
Air Inlet
Check Valve
1st Check d :
2nd Check /.,?
Initial Test
DC- Closed
Closed Tight
Opened at
Opened at
_psid
Tight
Leaked C3
�nsid
_._psid
RP- ,_,_,paid
Leaked o
Did not Open o
Leaked
Repairs
and
Materials
Used
Test Afar
DC- Closed Closed Tight o
Opened at
Opened at psid
Repair
Tight o
^ sid
_s nsid
RP
The above is certified to be trot.
Firm Name A
sr, ._ F. t �f ` CatiSai
Testa 4 -,
=4 ji
Firm Address
PO Eon -?°l-7 Cat.
Testa No.B,P~ 61 S''-2 Date i �3
Gauge #
Date last accuracy tested
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