2014_0624 CIIECK ONE:
IRRIGATION DOMESTIC PIRELINE
BACICFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
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NAME OF PWS: CITY OF COPPE'LL
PWS LD. #
LOCATION OF SERVICE: • - • te.4-
The backlIow prevention assembly detailed below has been tested and rriainrained as required by TNRCC
regulations and is certified to be operating within acceptable parameters_
TYPE OF ASSEMBLY
C / ' -• laced Pressure Principle c Pressure Vacinma Breaker
Y ,� M► r. Y J • ble Check Valve /- C7 Atmosphere Vacuum Breaker
Manufacturer 1
� Vir5 Size 04- k
Model Number 1--.1 " DO ZM 2 Located At .M¢ 1")YT s.1 /14.P C
Serial Number `/e9-2— I 3 7
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BRF A10ER
Doubie Cheek Valve Assembly
1st Cheek 1 2nd Check Relief Valve Air Inlet Cheek Valve
l a Test DC -C1 1, dosed Tight Z�Opened at Opened at nsid
/// Tight / ' ( Leaked o nsid nsid
y� RP- nsid
Leaked o /' Did not Open O Leaked o
Repairs
and
Materials
Used
Test After DC- Closed Closed Tight v Opened at Opened at nsid
Repair Tight o nsid nsid
RP psid
The above is certified to be true. \ �
Firm N. •. - y� �� �`� -�� _ Certified Tester 7:1 �T
0
Firm Address 4 . 4yL�� 6, Cert. Tester No.3PC6 8g /3 Date „A•-=z.2,1,/
Gauge # d y / 46 j�
Date last accuracy tested
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy