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2015_0212 (4)
C�iECK ONE: , IRRIGATION DOMESTIC L� FIRELINE BACT�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT rraME oF Pws: CITY OF COPPELL PWS I.D. # LOCATTON OF SERVICE: �� �'�' ��� r � °�` � rr� � - , ' ;��� �iJ�� � � The bacl�low preveation assembly detailed below has beea tested aad mainta�n� � nq� bv TNRCC re_�lations and is cerdfied to be operating within acceptable paramcters. TYPE OF ASSEMBLY � Reduced Press�ure Priaciple ❑ Pr�essure Vacu�Breaker �" Double Chxk Valve � Atmosphere Vacuum Breaker ��c���--� l �, Manufact�aer � Siu �. � Model N,mmba �'�.��� ��'�� r.�� �—Y � Locatea AL ��' �; ,:i ��` I-�-y � �G� Serial N�ber .� � � ��'�.f�� � REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Doubie Check Valve Assembly lst Check 2nd Checl: Reiief Valve Air Inlet Check Vaive Inival Test DGClosed Closed Ti�t �t' ed at Opened at �osid Ti Leal:ed ❑ f � sid _nsid _ R.P-�psid ---� � . �- ��. 1.5 �a a ► �a aoc op� o r,�t.� o �� �a Mataials Used Test Af3er DGClosed Closed Tight a Opeacd at Opeaed at __nsid Repair Tighi o ��sid __nsid RP sid The above is certified to be true. � � � / � Firm Name���� YY�' '�t�6']'�'t 1 Catifiod Teste _� � �� �"� �'''` �"���, '� ; F�� ��a���l�«��l s�- � r. Cert. Tester No. �I � Date d� � � ` � (��-Y"�^d1i, 1�Iwi'r 7�J�:" �1� '���7s� Gauge # ��r � v� � � c�- Date last accuracy tested � - �.' - � White- Customer's Copy Yellow - City Copy Pink-Tester's Copy .__ � _ _