2014_0312 (3)CHECK ONE:
IRRIGATION_LL DOMESTIC-0- FIRELINE W]
BACEFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: 1111C-100C.41
PWS I.D. #
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.
Hv�
TYPE OF 7LY
Reduced Pressure Principle Pressure Vacumri Breaker
Double Check- Valve
Atmosphere Vacuum Breaker
Manufacturer
Hersey
Size 3/4"
FDC
4 W corner of building
Model Number
Located At
Serial Number 001177
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VACUUM BREAKER
Double Check Valve Assembly
Ist Check-
2nd Check
Relief Valve
Air Inlet
Check Valve
Initial Test
DC-Closed
Closed. Tight
9
Opened at
Opened at
--jusid
f
Ti
0
R
Leak ed -
q
______psid
sid
Lml.-ed
Did Open 0
Leaked
not
Repairs
and
Materials
Used
Test After
DC-Closed
Closed Tight
C
Opened at
Opened at
psid
Repair
Tight C3
psid
psid
RP
j
=n�L
The above is certified to be true.
=M=
Firm Name Action - Fire Pros
Cadfied Taw Allen Stevens
Firm Address PO Box 797 Waxahachie Cat Tester Wo. 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