2014_0709 CHECK ONE:
IRRIGATION DOMESTIC ` FIRELINE
BACI FLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. # 1 5 nn c7 ��5� S��c� �,��� � Cm vie-1\
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LOCATION OF SERVICE: /L! / /I' gin ICS .1;57 r /Cd G7 01 ray arld Mt' OWr Cie
The baclelow prevention assembly detailed below has been tested and mail 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
Doub Check Valve D Atmosphere Vacuum Breaks
Manufacturer Wi irc Size 1 l
Model Number 007112 Grr Located At /3y wAfet ex,
Serial Number /9-1 93 lO
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAICER
Double Check Valve Assembly
1st Check 2nd Check Relief Valve Air Inlet Check Valve
Initial Test DC-Closed / Tight � Opened at Opened at nsid
Tight 2 - `r Leake 0 nsid nsid
PA $ s RP n
- Z
Leaked 0 2 Did not Open o Leaked 0
Repairs
and
Materials
Used
Test After DC- Closed Closed Tight a Opened at Opened at nsid
Repair Tight 0 sid nsid
RP paid
The above is certified to be true.
Firm Name -- 7: 1 1 - 1.t t ✓C' Certified Tester C C \ C\C\ l , �i
-- - . -,. -
rm �a
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Finn Address 7/P/ ova 1/. NUM . CerL Tester No. Q V 1 1 L 1 � I -7 Date 7 / j C 4 //V
75 22'7
Gauge # 1 7 �
Date last accuracy tested \O / � / L/
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy