2016_0901 C�IECK ONE: +� �,
�/s
IRHIGATION nOMESTIC FIRELINE
BACICF'LO'V���� �"��E1�ITON ASSEMBLY TES?AND MAIN`Y ENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: �� I S • �,�1( �a'DDg I I
The baci�low ptevention asscmbly detailod beloa has bxn tested aad maiatained as required by TNRCC
rcgulations and is catified to be operating withia acceptable paramtters.
TYPE OF ASSEMBLY
c Rcduced Pressare Priaciple e Pressurc Vacu�Breaker
� Double Check Valve ❑ Am�osphere Vacuum Breaker
Maaufact�aer ���`) S� ���� —
Model Iv�ber���,,,�f'_��" Located At � f7� � � I I�'
Serial N�ber �,���.� (���!�' �
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Doubl�Check Valve Assembiy
lst Check� 2nd Cluci: Relief Valve Air Inlet Check Valve
Initial Test DC-Closed Closed Ti,�ht � Opeaed at Opeaed at flsid
Tight 'l6 Leal:ed o �sid _,osid
RP- asid
�;� p Did not Opea o L,eaked �
�P�
aad
` Materials
Used
Test After DC-Closed Closed Tight o Optaod at Opeaod at _T sid
Repair Tight o esid osid
RP sid
The above is catified to be true.
Firm Name 1(Ot,�li 7�%�_ _ CeRifiod Testa C�U A�l �'CY�
Firm Address�6�=v.w�, ��� Cert Testa Nog����4Y�/ Date •/•l�
�3'l-?0
Gauge # ��fl 38�YZ
llate last accuracy tested �v '�7��G
White - Customer's Copy Yellow - City Copy Pink-Tester's Copy
C�iECK ONE:
IRRIGATION DOMESTIC FIRELINE� �
BACI�'LOW F�VENTION ASSEMBLY TEST AND MAINI'ENANC'E REP4RT
NAI�OF PwS: CITY OF COPPELL
PWS I.D. #
�
LOCATION OF SERVICE: � '
The bacicflow przveation asscmbly detailcd below has baa tested aad maintained as requircd by TNRCC
reguladons aad is cerdfied w be operatiag within acceptable paramtters.
TYPE OF ASSEEMBLY
e Reduced Pressure Priaciple e Pressure Vacu�Breaker
�. Double Check Valve o Amzosphere Vacuum Breaker
� � E
Maaufactsaer �.���� � ...� Siu �� 1 v�G�
Modei Number �`l�i�'�c� L,ocaud At 0 � �N �it'V��'
Scrial Nimmber ���� -
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Double Check Valve Assembly
lst Check�jo 2nd Checka.a Relief Valve Air Inlet Check Valve
Initial Test DC-Closed Closed Tight Opened at Opeaed at nsid
Tight 1� Leaked � _�sid __�sid
RP-_,psid
�� p Did not Opea o Leal:ed �
��
and
Materials
Uscd
Test After DC-Closed Closed Tight o Opeaod at Opeaed at _,..flsid
� Repair Tight o __Dsid __osid
Rp 'd
The above is certified to be true.
Fi:m Na�e��r r/i2 Certified Tester �� �'{i�
Firm Address�035����T l�lA r�_ Cat Testa N�A�I GYtI' D� . �/'G
����
c�auge # t!13o��(L
Date last accuracy tested 6�.�7 �6
White -Customer's Copy Yellow -City Copy Pink-TesteCs Copy