Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
2015_0212 (6)
C�IECK ONE: LR1tIGATION DOMESTIC � FIRELINE BACT�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPOR? NAME OF Pws: CITY OF COPPELL PWS I.D. # {.l i! k "� �� � �:� LOCATION OF SERVICE: H ► Y�,� 7�JD �.� " �.t i:f�`1 �.� v���1 i � c` �' The bacl�low preveation assembly detailed below has beea tested and maintained as required by TNRCC reguladons aad is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY � e�' Reduced Pressure Principle � Pressure Vacui�Breaker � Double Chxk VaIve o Atmosphere Vacuum Breaker Manufactzaer l�-J��i�r� Siu ���t � Model Nt�ber ��.._�'��� ►�°�� �� �--�� Located At �l h�t E��:.r�„� S�,., t �� ( f�-., . � �h P°v '�1,`-��. ��,�� fr� ,.._. (,� $CII31 TV1�bCf �":�"� --1 lJ ! � REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V�CUUM BREAI�R Double Check Valve Assembly lst Check 2nd Cbeci: Relief Valve Air Inlet Check Vaive Ininal Test DGClosed losed Ti,pht Opened at Opened at csid Tight Leal:ed ❑ ►�7 sid _�sid ,l� R.P-�7� sid 4'� �°��'��� Leal.ed ❑ �< �1 � Did not Opea o Leal:ed � � Repairs aad Mataials Usod Test After DC-Closed Closed Tight o ppeaod at Opeaed at �sid Repair Tighi O �sid osid R.P sid The above is certified to be true. Firm Name�r�1�; YYJ�����c�t; ;:� � Cectified Testet �� I �� ``'f�� �-�t 1.�(..5�'" Y� ^ r ry Firm Addres,s �l% Cert. Testar Na . � S Date � � ?� ' � `` ��,T�tl S �- �'�� ( � l, � �r��+� 4`� �; r ��'� '7 5�5 / Gauge # �..� �1 �r�+ � �� � llate last accuracy tested �— �` � � 'jp White- Customer's Copy Yellow - City Copy Pink-Tester's Copy � _ _