2014_0627 CHECK ONE:
IRRIGATION t/' DOMESTIC FIREIJ_NE
BACKFi.OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
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LOCATION OF SER ( 1/ VICE: � � J f 7 �
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The backflow prevention assembly detailed below has been tested and r as required by TNRCC
regulations and is certified to be operating within acceptable parameters.
TYPE OF ASSEMBLY
C Reduced Pressure Principle C Pressure Vac-utnn Breaker
�------ Double Check Valve C Atmosphere Vacuum Breaker
,
Manufacturer i � , G � 1 Size /„
Modes Number ‘"c" Located At P%-, 7 i-, .:
Serial Number )// Le-
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER
Double Check Valv
1st Check 1 2nd Cheek
Relief Valve Air Inlet Cheek Valve
Initial Test DC- Closed Closed Tiglil / 0— Opened at Opened at _psid
Tight C- v nsid _psid
RP- �- � psid
�� _ , _ / Leaked C Did not Opera o Leaked 0
Repairs
and
Materials
Used
Test After DC- Closed Closed Tight o Opened at Opened at nsid
Repair Tight 0 ______psid ______psid
RP psid
The above is certified to be true.
Firm Name 7. 2, - , , ; /� 1, ---, --s, / , Certified Tester 7: 7 ..-' .-? . ' 1
.'
Firm Address _1'2 `> 1 -: / /� -4 --cc "---- Cert. Tester No. *f � <..5' r Date' Z �? / 5•
Gauge # �J ,71st-' X/ j'
Date last accuracy tested Jl - j -- j `7>
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy