2014_0429CIIECK ONE:
IRRIGATION
DOMESTIC
\ \
FIRELINE
BACIO:'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PwS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: �/ 7 � /.f)�Lc_ -��'l/
The bacl�low prevention assembly detailed below has been tested aad maintain a5 required by TNRCC
re_eulations aad is certified to be opeating within acccptablc paramctas.
TYPE OF ASSEMBLY
C Reduced Pressure Principle C Pressure Vactnmm Breaker
Double Check Valve o Atmosphee Vacuum Breaker
Maaufaettrrer �� �- �t=-- 1�- �.�.�v Size
Model Number � �U Located At � - �cs�.�2�:��.( rrg- rv��c� �! 1' u '� ; ' - =� 1r
,1 •,�
Serial Number /t �% i 5 (o Z
The above is certified to be true. ,
,/� /
Firm Name �A =� t� r 1 �_r_`.e��' � -C�«� �� - tom(/. Certified Tester �r� •�/ (. ��i1_ ,�P-� j /1 -�
/ .-� / 7 �
Firm Address �= � z L r P -_r c +rte I - ! � i . _;�L Cert Teste No. tom' -� y ={� Date - Z "7 - �
GBUge # _ _ � � �� / C_� � C% `7
Date last accuracy testes 2 -. L� - r�
White - Customer's Copy Yellow -City Copy Pink - Tester's copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VACUUM B REAI� R
Double Check Valve Assembly
1st Check
2nd Checl:
Relief Valve
Air Inlet
Check Valve
Initial Test
DC- Closed 3 ���
Tight §�
Closed Tight �
Leaked o
Opened at
o sid
Opined at
n sid
o sid
RP- n sid
�� p
3 �
Did not Opm t7
L.eal:ed �
Repairs
and
Materials
Used
Test After
Repair
DC- Closed
Tight �
Closed Tight v
Opmod at
n sid
Opeaed at
o sid
n sid
RP sid
The above is certified to be true. ,
,/� /
Firm Name �A =� t� r 1 �_r_`.e��' � -C�«� �� - tom(/. Certified Tester �r� •�/ (. ��i1_ ,�P-� j /1 -�
/ .-� / 7 �
Firm Address �= � z L r P -_r c +rte I - ! � i . _;�L Cert Teste No. tom' -� y ={� Date - Z "7 - �
GBUge # _ _ � � �� / C_� � C% `7
Date last accuracy testes 2 -. L� - r�
White - Customer's Copy Yellow -City Copy Pink - Tester's copy