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2014_0323 (2)CHECK ONE: IRRIGATION DOMESTIC FIRELINE BACIOLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: PWS I.D. # CITY OF COPPELL LOCATION OF SERVICE: 1 q W 45- 5-2 l l'i'y U The back -low prevention assembly detailed below has been tested and maintained as required by TNRCC regulations and is certified to be operating within acceptable parameters. ❑ Reduced Pressure Principle Double C heck Valve Manufacturer t ,r! & Model Number La _% (1'i Serial Number �y 6) q-S� TYPE OF ASSEMBLY ❑ Pressure Vacuum Breaker ❑ Atmosphere Vacuum Breaker Size 2- Located At /�• ��ia��✓�Zl / �� The above is certified to be true. Firm Name% 4"A'Za Certified Tester ,�, L"Ld—; f Firm Address ©2"-1 3 c. /" r C►� Cert. Tester No. _3 Date -2 Gauge # 6 (U 2Z Z �(s Date last accuracy tested /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 _paid Tight -121' ,RP -] , psid Leaked o Leaked ❑ _osid nsid Did not Open ❑ Leaked- Repairs and Materials Used Test After DC- Closed Closed Tight ❑ Opened at Opened at ------ nsid Repair Tight ❑ Dsid _psid RP sid The above is certified to be true. Firm Name% 4"A'Za Certified Tester ,�, L"Ld—; f Firm Address ©2"-1 3 c. /" r C►� Cert. Tester No. _3 Date -2 Gauge # 6 (U 2Z Z �(s Date last accuracy tested /I White - Customer's Copy Yellow - City Copy Pink - Tester's Copy