2014_0213 (2)CIIECK ONE:
IRRIGATION
DOMESTIC
FIRELINE'
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. # ���t� C��1`�C Npp mf.t -4 -)
LOCATION OF SERVICE: vac Tx 7 S d !
The bacldlow prevention assembly detailed below has been tested and maintained as required by TNRCC
regulations and is certified to be operating within acceptable parameters.
C Reduced Pressure Principle
Double Check Valve
ManufacturerE
Model Number
Serial Number
TYPE OF ASSEMBLY
C Pressure Vacuum Breaker
o `Atmosphere Vacuum Breaker
Size I `6 '
Located At 1;9\U4
I
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VACUUM BREAKER I
Double Check Valve Assembly
1st Check
2nd Check
Relief Valve
Air Inlet
Check Valve
Initial Test
DC- Closed
Closed Tight o
Opened at
Opened at
osid
Tight C
RP-
Leaked
osid
osid
_, -psid
Leaked
Did not Open o
Leaked C
Reps
and
Materials
Used
Test After
DC- CIosed
Closed Tight o
Opened at
Opened at
,osid
Repair
Tight o
osid
osid
RP sid
If .
The above is certified to be true.
Firm Name _TA PA
Firm Address
ph�1�,s �k 75:7
Gauge # l 7
Date last accuracy tested - 'Q
Certified Tester M C 0 6 \ '��
Cert. Tester No � l q 1`7 Date
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy