2014_0312 (2)CHECK ONE:
IRRIGATION= DOMESTIC-0- FIRELIN
BACKYLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS:
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
Double Check Valve H Atmosphere Vacuum Breaker
Manufacturer Hersey size 3/4"
Model Number FDC
Serial Number
unreadable
Located At
SW corner of building
The above is certified to be true.
Firm Name Action Fire Pros Certified Tester Allen Stevens
11
Firm Address PO Box 797 Waxahachie Cat Testis 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
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
psid
Tight
RP.
L,.k-.d
Leaked
psid
tssid
Did not Open 0
Leaked
Repairs
and
Materials
Used
Test After
DC-Closed
Closed Tight 0
Opened at
Opened at
n sid
Repair
Tight
psid,
--_-psid
R?====_ ,gsid
The above is certified to be true.
Firm Name Action Fire Pros Certified Tester Allen Stevens
11
Firm Address PO Box 797 Waxahachie Cat Testis 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