2014_0711 CHECK ONE:
IRRIGATION x DOMESTIC FIRELINE
BACICFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS:
CITY OF COPPELL
PWS I.D. # p� I �,_- J 9
LOCATION OF SERVICE: l7 yO L c /971 L� L,R■
The bacldlow prevention assembly detailed below has been tested and mail-II as required by TNRCC
regulations and is terrified to be operating within acceptable parameters.
TYPE OF ASSEMBLY
C Reduced Pressure Principle C Pressure Vacuum Breaker
Double Check Valve c7 Atmosphere Vacuum Breaker
Manufacturer - - e L Size
Model Nummber Z � v Located At
Serial Number PI � � " J , 6 \
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER
Double Check Valve Assembly
1st Check 2nd Check Relief Valve Air Inlet Cheek Valve
Initial Test DC- Closed Closed Tight ° Opened at Opened at vsid
Tight Ft) )3B° � Leaked o vsid osid
RP- osid /f
Leaked a °r Did not Open O Leaked
Reps
and
Materials
Used
Test After DC- Closed Closed Tight a Opened at Opened at osid
Repair Tight osid osid
RP psid
- -- - - --
The above is certified to be true.
Film Name 01 Accuracy Bircle Certified Ctified Tester 7( .5 /25rio.f1-1/ / f I
Firm Address Frisco, TX 75033 Cert Tester No. 3 Date / -7 - 1 - 3
Gauge * o m9y
Date last accuracy tested -6 -pi
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy