2014_0425 (3)CIIECK ONE.
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IRRIGATION r DOMESTIC � FIRELINE �
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BACKFT.OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS:
PWS I.D- #
CITY OF COPPELL
LOCATION OF SERVICE: :�'�CP � - ��...�.. ���_ �s^C-
The bacl�low prcvmtion assembly detailed beiow has bem tested and maintain as required by TNRCC
regulations and is certified to be operating within acceptable parameters.
TYPE OF ASSEMBLY
Reduoed Pressure Principic C Pressure Va �-uu+±+ Breaker
�/, Double Check Valve � Atmosphere Vacuum Breaker
Manufacturer /_ � �� /� Size r ,Z •� / _ /
Model Number /`��J 7/✓'7 /�T Located At _ �? rtto'Y7�' c'+�L- ��- �'ZrGe- -S
Serial Number / �� 33 "��
The above is certified to be true.
Firm Name /� /. s [:L�FLr � � • �c��f Tsar Cetified Tester 1E_. ��G �' � �Y�iIZ�JU/`�
Firm Address �•^. 13d�,� i/� -�'� c�o7�/�.- u.�. -Cert Tester No. �' Date
`7�c�� ,�
Gauge # l�G'�F: �� / �- �/'�!
Date last accuracy tested _
z -:/z -��
White - Customer's Copy Yellow -City Copy Pink - Tester's Copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VACUUM B R�'A� R
Double Check Valve Assembly
1st Check
tad Cheel:
'ef Valve
Air Inlet
Cheek Valve
Initial Test
DC- Closed � �'�
Tight
RP- o sid
I,� p
.Closed Tight
Leaked o
�4' "
Opined at
o sid
Opined at
o sid
Did not Opm o
o sid
Leaked �
Repairs
and
Materials
Used
Test After
Repair
DC- Closed
Tight o
Closed Tight o
Opined at
o sid
Opined at
o sid
o sid
RP sid
The above is certified to be true.
Firm Name /� /. s [:L�FLr � � • �c��f Tsar Cetified Tester 1E_. ��G �' � �Y�iIZ�JU/`�
Firm Address �•^. 13d�,� i/� -�'� c�o7�/�.- u.�. -Cert Tester No. �' Date
`7�c�� ,�
Gauge # l�G'�F: �� / �- �/'�!
Date last accuracy tested _
z -:/z -��
White - Customer's Copy Yellow -City Copy Pink - Tester's Copy