2014_0611 CIIECK ONE:
IRRIGATION � DOMESTIC FIRELINE
BACI FLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL , i) -
PWS I.D. #
LOCATION OF SERVICE: , tjA ' , fie \ VV- V (�� -
The baddlow prevention assembly detailed below has been tested and 7naintAirted as required by TNRCC
regulations and is certified to be operating within acceptable parameters.
TYPE OF ASSEMBLY
e Reduced Pressure Principle 0 Pressure Vag"+++**+ Breaker
4z:iC . Double Check Valve ❑ Atmosphere Vacuum Breaker
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Manufacturer �l .vl Size 31 , ` 4
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Model Number S Located At 1' e,h � • �,, o �� A-11 „/ �-, `-"
Serial Number PC-." -
_._ - -- REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER
Double Check Valve Assembly
•
1st Check 1 2nd Cheek Relief Valve Air Inlet Cheek Valve
Initial Test DC- Closed Closed Tight Vat- Opened at Opened at nsid
Tight Leaked, 0 nsid nsid
RP- ' ' t i21._ i21._ psid .71-'1
Leaked m Did not Open o Leaked 0
R
and
Materials
Used
Test After DC- Closed Closed Tight 0 Opened at Opened at nsid
Repair Tight o vsid nsid
RP paid
— —
The above is certified to r be true.
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Firm Name � 6 ebv3 - . Cerrifl -- - _ . .Lst a — t . _ . .1 /,
Firm Address ) -5 , o {1S4.YA -e inrn� � f Cert. Tester No. 9� ' 1 , � Date '. f l' /L/
Gauge # 7
Date last accuracy tested - 2---I 12, I / L
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy