2013-0620 (2) C�IECK ONE:
IRRIGATION DOMESTIC FIRELINE �
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D.# '
LOCATION OF SERVICE: 7_�1`_�L l 1� � �'�' ✓ �4 ��� � � �r'�c �.,� �
The bacl�low prevmtion asscmbly detailed below has baa iested aad maint,�n� � nq�� by TNRCC
reguladons and is certified to be operating within acceptable paramcters.
TYPE OF ASSEMBLY
C Reduced Pressure Principle � Pressure Vacu�Breaktr
� Double Chcck Valve � Atmosphere Vacuum Breal:er
� � 1�� aL Siu ��`�
Maaufact�er �
Model Iv�ber ���'k ` � Locatcd At �l u•.��' s�� � �. u� �I J�
�� a�-�p� �
Serial N�ber 3 r7 �' 2 ti v o
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUIJM BREAI�R
Double Check v alve Assembly
lst Check 2nd Checi: Reiief Valve Air Inlet Check Valve
Initial Test DGClosed � Z losed Ti;ht Opened at Opeaed at osid
Ti�t Lcal:ed ❑ Dsid osid
R.P-_psid � . 7
I,�;� o Did not Opea o Leal:ed �
�P�
and
Materials
Used
Test Aft,er DGClosed Closed Tight o Opened at Opmad at _nsid
Repair Ti,Qht o osid osid
RP sid
The above is cerd6od to be true.
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Fum Name ���4'`r� ';.`�: :� �3�,t•, �� -��,�.^-Certifiod Testa 'il i�.a t�: �_�R: ic"�'7 �,� r;.�i:-�.�
�, ,
Firm Asidress � �''E::� �_� � `��.� Cert. Taster No ��f``��-`;i.� Date �t`Z�''
�tlq" � `� �� � , '` -?� � � '
C , �, ,` �, ��._.
Gauge # t� {d �t r "1 '�.�
1��, t,� � �
llate last accuracy tested �-� �' � �-
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy