2014_0428 CHECK ONE:
IRRIGATION DOMESTIC FIRELINE
BACIFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT ( i �
NAME OF PWS: CITY OF COPPELL
PWS LD. #
LOCATION OF SERVICE: -
The bacldlow prevention assembly detailed below has been tested and maintained as required by TNRCC
regulations and is certified to be operating within acceptable parameters.
TYPE OF ASSEMBLY
C Reduced Pressure Principle C Pressure Vacuum Breaker
` P Double Check Valve 0 Atmosphere Vacuum Breaker
1
Manufacturer " ' Size = S'
Model Number / / Located At r to
Serial Number/Vr `7" , ' /
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAICA
Double Cheek Valve Assembly
1st Cheek 2nd Check Relief Valve Air Inlet Check Valve
Initial Test DC- Closed - r Closed Tight ° `L- Opened at Opened at osid
Tight scr o osid osid
RP- osid
Leaked p Did not Open o Leaked O
Repairs
and
Materials
Used
Test Agar DC- Closed Closed Tight o Opened at Opened at osid
Repair Tight p . nsid osid
RP _ psid
The above is certified to be true.
Firm Name ' ✓ s r �O Certified Tester __. - : % 6.
1 {
Firm Address ; . Ole C =7 Cert. Testa No.-; 7n' //, Date _ r
Gauge # r - f - (n e
Date last accuracy tested _ , ! � `" 1 9 f
White Customer's Copy Yellow - City Copy Pink - Tester's Copy