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2015_0212 (7)
C�IECK ONE: IRRIGATION DOMESTIC � FIRELINE BACKFLOW PREVENTION ASSEMBLY TEST AND MAIIVTENANCE REPORT N�oF Pws: CITY OF COPPELL PWS I.D. # . ` � „ :... LOCATION OF SERVICE: t"� �' 7 J � r'� � '� ��«� '..� n � P, � , The bacl�low preveation assembly detailed below has bxa tesLed aad *++a�n a�n� � nq�� bv TNRCC re_guladons aad is certified to be operating withia acceptable parametcrs. TYPE OF ASSEMBLY e-'`� Reduced Pressure Principle ❑ Pressure Vacu�Breaker ❑ Double Check Valve o Am�osphere Vacuum Breaker , a � r Maaufactsaer �,c r�'��� ������� �`� Siu _ 1� � .-, �`'' i�°�_ Modei Number �.�C.- � ����._'� �.�� � Located At 1��t ��` �� � c ►�'=�; � [ ` �r� �'`�`��-�� ,.� �� Serial N�ber � ���--� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER Double Check Valve Assembly , lst Check 2ad Cbecl: Relief Valve Air Inlet Check Valve Inival Test• DGClosed Closed Ti;ht Opened at Opened at csid ` Tight Leal:ed o �nsid __osid �. {� " i� R.P- 7 '� sid I,eal;ed ❑ � �.J �►l� Did not Opea o Leal:ed � RePairs aad Mataials Used Test ARer DC-Closed Closed Tight o Opeaed at Opeaod at �sid Repair Tight 0 _nsid _osid R.P sid The above is certified to be t:ve. � I� - �� `1 _ 1 ;-�c'�:.J Fum Name 1��i�i +�e.0�a�� , c,<i Certifiod Testc IA�� ��`�<:n Y�'� � "��•�`�-�'`' `� Firm Address��f�S t.���I��'�=d�� Cert. Teste No. ��-�f ��. Date � "�� " I.� � ✓qrtcl f�ri%r o-�a i h ���.�� � Gauge # G'�11 ���1 �` llate last accuracy tested .�` � �1.� ' White- Customer's Copy Yellow - City Copy Pink-Tester's Copy _ i _