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2013_1218_RPZ (5)
CIIECK ONE: IRRIGATION DOMESTIC FIRELINE BACETLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE: IjAar 150 The bacl.'flow 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(n�Check Valve Manufacturer Z J a- -�S Model Number 00 Serial Number C9 83 ©C) TYPE OF ASSEMBLY ❑ Pressure Vacuum Breaker ❑ Atmosphere Vacuum Breaker Size Located At The above is certified - t -o�bee true. I - / I Firm Name Al / -4 �1 T Certified Tester � y /`e r 4ci A a. /e n Firm Address lr{ ' 41,0/A� TX 70 Cert. Tester No. Date_ Gauge # _060 7,17 ?V Date last accuracy tested -7-10-1,3 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 5 DC- Closed Tight RP -��sid Closed Tight Leaked ,/ ❑ / I Opened at �, Q osid Opened at osid osid Leaked ❑ Did not Open ❑ Leaked ❑ Reps and Materials Used Test After DC- Closed Closed Tight o Opened at Opened at p sid Repair Tight ❑ osid osid RP sid The above is certified - t -o�bee true. I - / I Firm Name Al / -4 �1 T Certified Tester � y /`e r 4ci A a. /e n Firm Address lr{ ' 41,0/A� TX 70 Cert. Tester No. Date_ Gauge # _060 7,17 ?V Date last accuracy tested -7-10-1,3 White - Customer's Copy Yellow - City Copy Pink - Tester's Copy