2014_0312 (5)CHECK ONE:
IRRIGATION= DOMESTIC .. FIRELINF,___L]_
BACIOLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: e 11) 0
PWS I.D. #
217 Wrangler Drive Coppell, Tx.
LOCATION OF SERVICE:
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 Brcaker
R,O( Double Check Valve H Atmosphere Vacuum Brealmr
Manufacturer Wafts size 211
ModclN=bcr 007M1
Located At N. Side @ Street
Serial Number 88163
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VACUUM BREAKER
Double Check Valve Assembly
Relief Valve
Mr Inlet
Check Valve
I st Check
2nd Check
Initial Test
DC-Closed
Closed Tight
Fr
Opened at
Opened at
ins
P4) 5&v�
Tight EY
RP- �Xsidff
Leaked
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—L/:/.
Leaked
Did not Open 0
Leaked ❑
Repairs
and
Materials
Used
Test After
DC-Closed
Closed Tight
a
Opened at
Opened at
Repair
Tight
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RP sid
The above is ratified to be true.
Action Fire Pros
Firm Name
Certified T Allen Stevens
est=
Firm Address PO Box 797 Waxahachie Cert. Tester No. BP0009860 Dam 3-12-14
Gauge # 07090476
Date last accuracy tested 9-27-13
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy