2014_0425CIIECK ONE:
IRRIGATION
DOMESTIC
FIREI.INE � �
BACKFLOW PREVENTION ASSEMBLY TEST AND MAII�iI'ENANCE REPORT
NAIL of Pws:
CITY OF COPPELL
PWS I.D. # f��r- ,QIIC�� ��/G�2 / -� /
LOCATION OF SERVICE: �� � • �,,.�.sLu �C�. �.�-
The bacicflow prevCatioa assembly detailed below has b een tested and maintain gg mQuircd by TNRCC
regulations and is certified to be operating within acccptablc parameters.
� ���i��R3►���
C Reduced Pressure Principle C Presstac Va c-ut+**+ Breaker
Double / Check Valve C Atmosphere Vacuum Breaker
Manufacan-er ���t5 P � Size ��'�
Model Nt�ber 6�C / 5 /� Located At 4�� �M� iO,r�c�� � �!'Cd��o .S�
Serial Number ^ �f�0 Wi' Zq
The above is certified to be trtte.
Gauge # D/o,U/�/ !i 9�
Date last accuracy tested ! Z - /� - /3
White - Customer's Copy Yellow -City Copy Pink - Testers Copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VACiJUM B R�'e� R
Double Cheek Valve Assembly
1st Cheek
2nd Cheek
'ef Valve
Air Inlet
Cheek Valve
Initial Test
DC- Closed z Z—
sed Tight
Opined at
Opened at
a sid
S
Tight
RP- a sid
L,� C
Leaked 0
�Z - '�
a sid
a sid
Did not Opea o
Leaked �
Repairs
and
Materials
Used
Test ARer
Repair
DC- Closed
Tight [7
Closed Tight o
Opened at
a sid
Opened at
a sid
o sid
RP sid
The above is certified to be trtte.
Gauge # D/o,U/�/ !i 9�
Date last accuracy tested ! Z - /� - /3
White - Customer's Copy Yellow -City Copy Pink - Testers Copy