2014_0727�
C�IECK ONE:
,
IRRIGATION � DOMESTIC FIBELINE
BACI�LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPOR?
NA,N�OF PWS: CITY OF COPPELL
PWS I.D.#
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LOCATION OF SERVICE: .� � � t ��r� � r �
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The bacl�low prevmtion asscmbly detaile� below hasGbeea testcd aad �,a; t�ed as required by TNRCC
regulanons'aad is certified to be operating withia acccptable paramcters.
TYPE OF ASSEMBLY
�C Reduced Pressure Principle e Pressure Vacu�a Breaker
,,e�'� Double Check Valve o Amiosphere Vacuum Breaker
Manufact�er '��n�%��" � Siu `--�;''!�
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' Model Ivumber ; - ` Located At *'y��• r f`�, --'
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$CiI31 TV1mmbQ �� � ��, � �.
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BI�EAI�R
Double Check Yalve Assembly
lst Check 2nd Checl: Relief Valve Air Inlet Checic Valve
t
Ininal Test DC-Closed�`-�' Closed Tight Opeaed at Opened at .. osid
Tight Leal:ed o vsid :osid
RP-_�sid
�;� p Did not Opea o Leal:ed � _
Rtpaus
and
Materials
Used
Test After DC-Closed Closed Tight o Opeaed at Opeaed at �sid
Repair Tight ❑ �sid osid
RP sid
The above is cadfiod to be we. �
P r �r
Firm Name �i�/�' ✓�i�"� Certifie�Testc ---''�', �"`�^ ,•'l✓,�
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Firm pddras�� r �r�,� + -� ��'� Cert Te�No.j .� �" D�`�= � � !�'�
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Gauge # ��✓ �,. /�A::C,
Date last accuracy tested
- White - Customer's Copy Yellow - City Copy Pink-Tester's Copy