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CHECK ONE:
IRRIGATION L DOMESTIC FIRELINE
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
97.
NAME OF PWS:
CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: 6 7 "1= Z
The baclllow prevention assembly detailed below has been tested and mainrained as required by TNRCC
regulations and is certified to be operating within acceptable parameters.
TYPE OF ASSEMBLY
C Reduced Pressure Principle 0 Pressure Vacuum Breaker
r3� Double Check Valve 0 Atmosphere Vacuum Breaker
Manufacturer S ize
Model Number � c J Located At
Serial Number 11/7 k 7`7‘7 'r-/
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI:ER
Double Cheek Valve Assembly
1st Check 2nd Check Relief Valve Air Inlet Check Valve
Initial Test DC- Closed Closed Tigh?" at Opened at nsid
Tight caked 0 nsid nsid
RP- ) nsid
f7 ;� ek p Did not Open o Leaked 0
Repairs
and
Materials
Used
Test After DC- Closed Closed Tight o Opened at Opened at nsid
Repair Tight [] nsid nsid
RP psid
The above is certified to be true.
Firm Name l %; 7 G J s � Certified Tester rC
Firm Address �� `r � — / /, . G J x Cert. Tester No. !? F `r Date - 1 - 7/— / y
Gauge # " 7/C- - 't-//Z
Date ]last accuracy tested j — y
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy