2014_0709 (3) CIIECK ONE:
IRRIGATION DO MESTIC FIRELINE
BACKFI.OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. # N5`3® E'• o,S� S�n� 1 Co p_l\
LOCATION OF SERVICE: derr OAKS 4aufri t u /n7 a44 Aler�r/� bare
The bacldlow prevention assembly detailed below has been tested and rnnintained as required by TNRCC
regulations and is certified to be operating within acceptable parameters.
TYPE OF ASSEMBLY
C� Reduced Pressure Principle C Pressure Vacutma Breaker
1 5� Double Check Valve pata(' Atmosphere Vacuum Breaker
WAITS- »
Manufacturer W/Y �s Size y'
Model Number AO '7,9 3 Qn Located At vA.a7 'Sz1,✓ Of P iced y
Serial Number 270 4
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BRF'AICER
Double Check Valve Assembly
1st Check 1 2nd Check Relief Valve Air Inlet Check Valve
Initial Test DC- Closed Closed Tight bill Opened at Opened at nsid
Tight Z.2 6 Leaked o nsid nsid
PA 5 C Rl nsid 2 y
Leaked o Did not Open O Leaked
Repairs
and
Materials
Used
Test After DC- Closed Closed Tight o Opened at Opened at nsid
Repair Tight 01 sid nsid
RP psid
The above is certified to be true.
Firm Nye /d4/2- I Certified Testa 1 11 0.f / AA ( 6)(t ( 6)(t7 1 1
Firm Address 7 Ca- f r • St D f A' Cert. Tester No. 'BP0 > Date 7/17I
,AS z2 7
Gauge #
hate last accuracy tested' 1
/
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy