Loading...
2015_0508 C�IECK ONE: IRRIGATION � DOMESTIC FIBELINE BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAIv�OF PWS: CITY OF COPPELL PWS I.D. # LOCATIOIv'OF SERVICE: � + � �rS ��� �"�.�'v�;� ��i �-t:%��f�l l � � �J�'? i `� ; The bacl�low prevention assembly detailed below has beea tested aad maintained as required by TNRCC reguladons aad is cerdfied to bc operating within acr.eptable paramcters. TYPE OF ASSEMBLY e Reduced Pressure Principle C Pressure Vacut�Breaker Zlf' Double Check Valve ❑ Amiosphere Vacuum Breal:er .� �j Maaufact�aer ;�.' `� Siu Modei Number � ���._i� �` � �6t i Located At �,t��f'";8L'S�> � �:L-�� U��=�t� k.���r /1":-C.�-t:b'.. Scrial Nimmber �'' �`�� �-j REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Check Valve Assembly lst Check 2nd Checl: Relief Valve Air Inlet Check Valve Initial Test DC-Closed Closed Ti;ht Opeaed at Opened at _csid � Ti�ht, � Leal:ed o nsid __osid ' �'���"I� �'�sid � � �� �;� p Did not Opea o Leal►ed o RePairs � and Mataials Used Test Aft,er DC-Closed Closod Tight o Opeaed at Opeaed at �sid Repair Tighi � nsid _,osid RP sid The above is catified to be true. Firm Name ��"%��r i Y"�1�.!�i��; �'t r `��.� Certifiod Testa � 4+ �� a �-� rv� L._��t���' �/ � r.. `I:.�� i.���,��r'���_ Cert. Tester No. �-_:�,��':� 1 1 �f S�Date � - �;�- �J Firm Address�y_, , ;��d`-y s7;;� �C`..,'!�,r', `e,';+.. '��;,:�� Ga� � �'�11 t��a�1 c� llate last accuracy tested ��� za� " �� White - Customer's Copy Yellow - City Copy Pink-Tester's Copy