2012_0730_RPZCHECK ONE:
IRRIGATION DOMESTIC FIRELINE
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS:
PWS I.D. #
CITY OF COPPELL
LOCATION OF SERVICE: I D5 8. DkAok A P R 6. ° f -LEV&N --& 359 .2 6
The baclilow prevention assembly detailed below has been tested and maintained as required by TNRCC
regulations and is certified to be operating within acceptable parameters.
d/
Reduced Pressure Principle
❑
Double Valve
Manufacturer
Check
'v ` P� T S
Model Number
0 q /A 2
Serial Number
1,Z ,l
TYPE OF ASSEMBLY
❑ Pressure Vacuum Breaker
❑ Atmosphere Vacuum Breaker
Size PUMP Located At NP, V4//�AS d P
The above is certified to be true.
Firm NamZIL & -tLFWw s9V)46
Firm Address WE gr K" g Tie
",44 Lz48
Gauge # 0, /d 096b
/,
Date last accuracy tested -z' /Z
PRESSURE VACUUM BREAKER
Air Inlet
Opened at
osid
Check Valve
osid
Did not Open ❑ 1 Leaked ❑
Opened at I _- sid
osid
Certified Testa DWAI I f- G RA T
Cert. Taster No. Poa088 6 3 Date 7--3o-1Z
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
Double Check Valve Assembly
1st Check
2nd Check
Relief Valve
Ini Test
%� 55
DC- Closed
Tight
RP-�sid
Leaked ❑
Closed Tight
Leaked ❑_I
%2-
Opened at
-sid
Reps
and
Materials
Used
Test After
DC- Closed
Closed Tight ❑
Opened at
Repair
Tight ❑
osid
RP sid
::�l
The above is certified to be true.
Firm NamZIL & -tLFWw s9V)46
Firm Address WE gr K" g Tie
",44 Lz48
Gauge # 0, /d 096b
/,
Date last accuracy tested -z' /Z
PRESSURE VACUUM BREAKER
Air Inlet
Opened at
osid
Check Valve
osid
Did not Open ❑ 1 Leaked ❑
Opened at I _- sid
osid
Certified Testa DWAI I f- G RA T
Cert. Taster No. Poa088 6 3 Date 7--3o-1Z
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy