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2011_1216_RPZ (3)
CHECK ONE: IRRIGATION DOMESTIC FIRELINE BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # Mar' Y�e4 �`«�2 -�- � 510 LOCATION OF SERVICE: �j O d -)se n4 n 4. D 1� The back-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 Check Valve Manufacturer Model Number © q Serial Number od TYPE OF ASSEMBLY ❑ Pressure Vacuum Breaker ❑ Atmosphere Vacuum Breaker Size Located At /I/��eGI� • 1��0 Af- CUUM BREAKER Check Valve osid Leaked ❑ _psid The above is certified to be true. Firm Name Certified Tester n Ll Firm Address F-7` N/or�f'h. %� 7G zY Cert. Tester No. AP00 13,511 Date 2 �� Gauge # 0(011 O O (O(l Date last accuracy tested White - Customer's Copy Yellow - City Copy Pink - Tester's Copy REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VA Double Check Valve Assembly 1st Check 2nd Check Relief Valve Air Inlet Initial Test Q DC- Closed Tight �i,$ RP -_psid Leaked ❑ Closed Tight X Leaked ❑ �. Opened at ��_psid Opened at osid Did not Open ❑ Repairs and Materials Used Test After DC- Closed Closed Tight o Opened at Opened at Repair Tight ❑ osid osid RP sid CUUM BREAKER Check Valve osid Leaked ❑ _psid The above is certified to be true. Firm Name Certified Tester n Ll Firm Address F-7` N/or�f'h. %� 7G zY Cert. Tester No. AP00 13,511 Date 2 �� Gauge # 0(011 O O (O(l Date last accuracy tested White - Customer's Copy Yellow - City Copy Pink - Tester's Copy