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2014_0212 (3)CHECK ONE: IRRIGATION DOMESTIC X FIRELINE BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: PWS I.D. # CITY OF COPPELL LOCATION OF SERVICE:, 00 Fr�x—oaar -t The back-flow prevention assembly detailed below has been tested and maintained as required by TNRCC regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY C Reduced Pressure Principle 0 Pressure Vacuum Breaker !Y Double Check Valve © Atmosphere Vacuum Breaker Manufacturer LJJ ATTS Size z ► ► Model Number Do -7 m 119 Z- Located At Serial Number The above is certified to be true. Firm Name _PA,-, �;C 674, •., s Certified Tester r/ OA n Firm Address /0g T Cert. Tester Noted D!S-3,S! / Date .2-1,2 -/ Gauge # _ 0!d / t3 3 0 3 o Date last accuracy tested 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 2 _/ Z _ /L{ DC- Closed Tight RP- _L. 9 psid Leaked 0 Closed Tight Leaked 0 2.0 Opened at nsid Opened at nsid Did not Open 0 nsid Leaked 0 Reps and Materials Used Test After Repair DC- Closed Tight 0 Closed Tight o Opened at nsid Opened at nsid ---- nsid RP sid The above is certified to be true. Firm Name _PA,-, �;C 674, •., s Certified Tester r/ OA n Firm Address /0g T Cert. Tester Noted D!S-3,S! / Date .2-1,2 -/ Gauge # _ 0!d / t3 3 0 3 o Date last accuracy tested White - Customer's Copy Yellow - City Copy Pink - Tester's Copy