2013_0121_RPZCIIECK ONE:
IRRIGATION
DOMESTIC *,
FIRELINE
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS:
PWS I.D. #
CITY OF COPPELL
LOCATION OF SERVICE: 07025- E AR % A(/D0/`l3 I: Ss (n N%0 ,
The backflow prevention assembly detailed below has been tested and maintained as required by TNRCC
regulations and is certified to be operating within acceptable parameters.
e' Reduced Pressure Principle
Double Check Valve
Manufacturer LA/;/k: .,s
Model Number 97S 61-7---
Serial Number 94 '9
TYPE OF ASSEMBLY
C Pressure Vacuum Breaker
o Atmosphere Vacuum Breaker
size k0?
Located At Wake AIc�3e-r- Z1h sic '\-
The above is certified to be true.
Firm Name %t s Certified Tester Lo t a ,-�
Firm Address ysvX /%%. �:,��� d�u� Ln Cent. Tester No.72 n c 3 55// Date f - a// 3
Gauge # oeo //O O G !9
Date last accuracy tested gr- /�_
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
A5 j
DC- Closed
Tight eleaked
RP --k-2-psid
Leaked o
Closed Tight
0
S-C)
Opened at
07, -1/ psid
Opened at
nsid
Did not Open o
csid
Leaked
Reps
and
Materials
Used
Test After
DC- Closed
Closed Tight o
Opened at
Opened at
_ nsid
Repair
Tight o
nsid
osid
RP sid
The above is certified to be true.
Firm Name %t s Certified Tester Lo t a ,-�
Firm Address ysvX /%%. �:,��� d�u� Ln Cent. Tester No.72 n c 3 55// Date f - a// 3
Gauge # oeo //O O G !9
Date last accuracy tested gr- /�_
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy