2011_1216_RPZCHECK ONE:
IRRIGATION DOMESTIC_ FIRELINE
BACIGLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
r
NAME OF PWS:
CITY OF COPPELL
PWS I.D. # m4rk,-� 51",, - 5- � i
LOCATION OF SERVICE: 700 Al. . —Pn 4o n I K ie 12d.
The bacltilow prevention assembly detailed below has been tested and maintained as required by TNRCC
regulations and is certified to be operating within acceptable parameters.
TYPE OF ASSEMBLY
Reduced Pressure Principle ❑ Pressure Vacuum Breaker
❑ Double Check Valve ❑ Atmosphere Vacuum Breaker
Manufacturer, 00,445 Size
Model Number 002 Located At �� �, K ,` �c i, �h u rje r Si n IG
Serial Number 5490(o,5
The above is certified to be true.
Firm Name A -
11 l,;s - +
Certified Tester 4n zQ
� rn
Firm Address r4- Al r4. 7X 7(OY5 Cent. Taw No. M 013 5 `{1 Date
Gauge # D !p // DOfP 9
Date last accuracy tested
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
-24
DC- Closed
Tight /
RP- -,psid _
Leaked ❑
Closed Tight
Leaked o
D
Opened at
a" ° psid
Opened at
nSid
Did not Open o
nsid
Leaked O
Repairs
and
Materials
Used
Test After
DC- Closed
Closed Tight o
Opened at
Opened at
___--p sid
Repair
Tight ❑
nSid
nsid
RP sid
The above is certified to be true.
Firm Name A -
11 l,;s - +
Certified Tester 4n zQ
� rn
Firm Address r4- Al r4. 7X 7(OY5 Cent. Taw No. M 013 5 `{1 Date
Gauge # D !p // DOfP 9
Date last accuracy tested
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy