2014_0312 (6)CIIECK ONE:
IRRIGATION 17 DOMESTIC. FIRELINE— F-1
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: L F 621-) 0---a
PWS I.D. 4
LOCATION OF SERVICE: 217 Wrangler Drive Coppell, Tx.
The backflow prevention assembly detailed below has been tested and maintained as required by TCEQ
regulations and is certified to be operating within acceptable parameters.
TYPE OF ASSEMBLY
Reduced Pressure Principle Pressure Vacuum Breaker
RV(
Double Check Valve
H Atznosphere Vacuum Breaker
Manufa=er Febco
Size 211
Model Nurnber 805Y
Located At N. Side @ Street
Serial N=bcr 158200
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
Tight Q jQ
Leaked
------psid
...... psid
Leaked
Did not Open 0
Leaked
Repairs
and
Materials
Used
Test After
DC-Closed
Closed Tight
C
Opened at
Opened at
psid
Repair
Tight 0
psid
—_____-_psid
RP sid
The above is certified to be true.
611
Action Fire Pros
Firm Name
Allen Steven,��
Certified Tester
PO Box 797 Waxahachie BP0009860 3-12-14
Firm Address Cert. Tester No. Date
Gauge # 07090476
Date last accuracy tested 9-27-13
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy