2014_0619 __71Z / eq.
CHECK ONE:
HLRIGATION � DOMESTIC F IRELINE
6
BACKFLOW PREVENTION AS B
SEMLY 'PEST AND MAINTENANCE REPORT' -
7
NAME OF PWS: CITY OF COPPEE
PWS I.D. #
LOCATION OF SERVICE: � .• — — — — soma.. S u l
The baclllow prevention assembly detailed below has been tested and trill rained as requited by TNRCC
regulations and is certified to be operating within acceptable parameters.
TYPE OF ASSEMBLY
0 Reduced Pressure Principle ❑ Pressure Vacuum Breaker
9C Double Check Valve ❑ Atmosphere Vacuum Breaker 4 F
Manufacturer � t'S l a:7 Size
f "
Model Number k'5 e;' Located At � L.A._-. j-e-e—,_- h'N-te.-`
Serial Number l / � 4 7 � 24
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER
Double Check Valve Assembly
1st Check 2nd Cheek Relief Valve Air Inlet Check Valve
- _
Initial Test DC- Closed Closed Tight ❑ Opened at Opened at nsid
Tight ❑ Leaked ❑ nsid nsid .y.. -
RP- nsid
Leaked Did not Open ❑ Leaked ❑
Repairs � �2 ( C' 1%
and
Materials
Used
Test After DC- Closed Closed Tight j( Opened at Opened at osid
Repair Tight osid nsid $`
RP f - , Le° psid 2 • S
The above is certified to be true.
Firm Name Eld b,31 u > Si Certified Tester �� ,."1� 7' /� S' A` /
Firm Address < 0 Z z C 2 '� 1) Cat. Testa No. 8 P .2 `/ 3 e--) Date 6' - /9 - /�L
Gauge # // 0/ c:9.-./ �/
17ate last accuracy tested ,�, - 4 -- 1 `/
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy