2013_0607CHECK ONE:
IRRIGATION DOMESTIC FIRELINE_ i
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS:
CITY OF COPPELL
PWS I.D. # —
LOCATION OF SERVICE:
Tie bacldlow prevention assembly detailed below has been listed and aoaiawiaed as required by TNRCC
regulations and is certified to be operating within acceptable parameters.
e Reduced Pressure Principle
ca' Double Check Valve
Manufacturer
TYPE OF ASSEMBLY
0 Pressure Vacuimm Breaker
o Atmosphere Vacuum Breaker
Size 1 e( -D C
Located At L a u n Q r Y
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 Closers Tight e Opened at Opened at .. --°Sid
�dSS Tight 92, R Lead ° Dsid - - --psid
11 v�5 -)3 std o a , c� Did not Open ° Leaked o
Reps
and
Materials
Used
Test After I DC- Closed Closed Tight o I Opened at . �t:sid
Repair Tight ° --_-
The above is certified to be am
Firm Name C`Ys h � �' ,
Paa'fL±L-P, Certified Tester _ --
Fum Address L Dace ,
Cert. Tester No vi
Gauge # G c10 Q I0
Date last accuracy tested �?� -7—t 3
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy