2013_0607CHECK ONE:
IRRIGATION DOMESTIC FIRELINE'
BAC OWW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. # —
LOCATION OF SERVICE:
The bacidlow 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 Check Valve
Manufacturer 1 A) f / A� nn S
Model Numbs 3.r 0
Serial Number .9°2 e q5 9 %
TYPE OF ASSEMBLY
e Pressure Vacuum Breaker
O Atmosphere Vacuum Breaker
size / _D (f
Located At Ga U nd r-Y
The above is certified to be true. 7
Firm Name
S r1 t� , Pdkhn Certified Taster _D
Firm Address —2 --� Cent. Tester N v
Gauge # 0'/0 (j;) /q 3 j �
Date last accuracy tested c � -N3
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VACUUM BREAKER
Double Check Valve Assembly
Relief Valve.
Air inlet
Check Valve
1st Chew
2nd Check
Initial Test
1 a 55
1 -a�-13
DC- Closed
T ight o2 ,g a
—Ps'd o
Leaked
Closed Tight e
Leaked 0
3(c
Opened at
psid
Opened at
--psid
Did not Open o
_!rsid
Leaked fl
Repairs
and
Materials
Used
Test After
Repair
DC- Closed
Tight
Closed Tight o
Opened at
_p sid
Opened at
__4sid
nsid
RP
The above is certified to be true. 7
Firm Name
S r1 t� , Pdkhn Certified Taster _D
Firm Address —2 --� Cent. Tester N v
Gauge # 0'/0 (j;) /q 3 j �
Date last accuracy tested c � -N3
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy