2014_0624 (2) CIIECK ONE: /
IRRIGATION // •
DOMESTIC FIRELINE
BACI FLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT —, .
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: 7342 At IJeJI)TEDA) AP ..1D. --- -. )1 1 ./../L' OI` {frie.13dA
The baekflow prevention assembly detailed below has been tested and rneinra;ned as required by TNRCC
reeulations and is certified to be operating within acceptable parameters_
TYPE OF ASSEMBLY
c Reduced Pressure Principle C Pressure Vacuum Breaker
..lam Double Check Valve o Atmosphere Vacuum Breaker
Manufacturer r l=a c_ o Size
Model Number 8S Located At ANerAL a fi0 ��P ,zNTRAA) ems.
Serial Number 74 167i9.Z 3
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAICER
Double Cheek Valve Assembly
1st Check 1 2nd Cheek Relief Valve Air Inlet Cheek Valve
Initial T DC- Closed / osed Tight `v' Opened at Opened at osid
Tight A �f Leaked 0 osid osid
S RP- psid
Leaked o °: ' Did not Open O Leaked 0
Repairs
and
Materials
Used
Test After DC- Closed Closed Tight o Opened at Opened at psid
Repair Tight o psid psid
RP psid
The above is cc-er ified to be true_ �� �- ' ' A QQ w , - `
Firm Name K ��Ki 4 -0 �K �.S Certified Tester 1��1E !�/�✓- /
Firm Date Address / ��-Z IAS�� /r � G� -� V
/ �K V�vG Tx �,Soe - Cert. Tester No. Al
Gauge # o44a0
Date last accuracy tested 4 7— / —,"
White - Customer's Copy Yellow - City Copy Pink - Testers Copy