The URL can be used to link to this page

2014-1001 _ � C�IECK ONE: . �� IRRIGATION DOMESTIC FIRELINE �, BACI�ZOW PREVE3�'ION ASSEMBLY TEST�iND MAINTENANCE REPORT � � NAIv�0 CITY OF COPPEL�, , F PWS: . . , �, � . , ; : , < , � , � , PWS I.D. # � , � y �_ � � LOCATION OF SERVICE: f�=�'d .��, �� '�`�1.,��`l� � �� %� ' � �� The bacl�low preveation assembly detailed below has bxa tested aad maintained as required by TNRCC regulations and is certified to bc operating within acceptable paramcters. TYPE OF ASSEMBLY e Reduced Pressurc Principle � Pressurc Vacui�Breaker ;� Double Chcck V�v��.,F 4�_ , . , ;❑ , - A�nosphe�c Va�u�m Brea�er , . . - . . ...5. y..�. .. �.. !� � '_j � ,�� i .._ ,d . .. " . . „ . ,. � � �( � �I �t . Manufact�aer S� Modei Number �--�G'C��r��`1 � Located At � I,J� if� ` Serial Nimmber �o� � `� �' � REDUCED PRESSURE PRINCIPLE ASSEMBLY PitESSURE VACUUM BREAI�R ' i Double Check v alve Assembly ; � ,, , . . . . �.. � . � .. . .. . . . � �. . ..�k � _ lst Check �nd Checi: ' :Rdief Valve Air Inlet Checic Valve ; Initial Test DGClosed 1 t.� Closed Tight Opeaed at Opea�d at nsid �° Tieht � Leal:ed ❑ _�sid _osid ` R.P-_psid �, � Leal;ed o Did not Opea o Leal:ed o �P� and Mataials Us�d � � . � � ' . � _ . Test After DGClosed { Closed Tight o Opeaed at` Opmed at f _ _ o§id ` Repair Tight o nsid osid R.P sid The above is certified to be tnu. r. ( � Firm Name �`�'�''t 5 ��- r�� Certifiod Testa ��t 1 i� � �.5 FirmA �. C�c �o� �+-�;, -� Cert. Tester No. �' � Date�°�" c�—/�" t f r i��c?�`-��r ( C�.�"�� ; , Gauge'# a��'�.1?C;� �1 �� . ; s. llate last accuracy tested �� /- � White - Customer's Copy Yellow - City Copy Pink-Tester's Copy