2013_1105 (3)CHECK ONE:
IRRIGATION DOMESTIC FIRELINE44
BA OW PREVENTION ASSEMBLY TEST AND MAUMNANCE REPORT
NAME OF PWS. CITY OF COPPELL
PWS I.D. # A4 A.—
LOCATION OF SERVICE: J 121 S e-64d
The backflow prevention assembly detailed below has been tested and maintained as required by TNRJ
regulations and is certified to be operating within acceptable parameters.
Serial Number lz2b�i_
Cat Testa No. 8 0 1* - ' Date i 1 -3 13
Date last accuracy tested 61-Ib---
White - Ctistomer's Copy Yellow - City Copy Pink - Tester's Copy
REDUCED PRESSURE PRINCITLE ASSEM13LY
PRESSURE VACUUM BREAKER
Double Check Valve Assembly
1st Check
2nd Check-
Relief Valve
Air Inlet
Check Valve
Initial Test
DC-Closed
Closed 'right
Z-4
Opened at
Opened at
---psid
Tight T"
Leaked
0
_psid
____.psid
Ri-_Li
/_psid
%.
Leaked 0
Did not Open (0
Leaked
Repairs
and
Materials
Used
Test After
DC-Closed
Closed Tight
M
Opened at
Opened at
nsid
Tight 0
-sid
----- —pair
_psid
E7
RP--_psid
The above is catified to be true.
Cat Testa No. 8 0 1* - ' Date i 1 -3 13
Date last accuracy tested 61-Ib---
White - Ctistomer's Copy Yellow - City Copy Pink - Tester's Copy