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Coppell CC 1B1-LR010917 (7)
'CtlECK ONE: IRKIGATION DOMESTIC I~IRELINE X BACKi~OW PRI~VENTION A~SF.,MBLY 'lEST AND MAINri~NANCE REPORT NAIv~ OF PWS: PW$ I.D. # LOCATION OF SERVICE: ~0 ! ~reel~a~- Th," ba~ilow prevention assembly d~tail~ b~low has be~n tested and m.i.t.i.~l as ~ by. TNRCC m.~mlahonz and is c~xified to be operating within ac~ptable parame~r~. Manufacturer P.*duc*d Pressur~ Print/pie Double Ch~k Valve Mod~l Numb= "~'~ ~ )~ Serial Number (~ 0 ~ ~/ ! TYPE OF ASSEMBLY Pr~ssur~ Vacuum Breaker [] Armospher~ Vacuum Bre 'aker REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACI~IM BREAKER Double Check Vslve~ Assembly 1st Check.[ 2nd Check Rellef~'-allle Air Inlet~-"neck Valve r DC-Clos,~i t,~ Closed Titht ~Opened at ~ a,Q~edato .s~ psid Ti~t '~,'-' ~ Leaked ~/.O ~ psid · 'I~- psid and l~air Tight ~ _~..~_p,id paid 1~ The above is cer~fied to be ~ru~. Date last accuracy tested White - Customer's Copy Yellow - City Copy Pink - Tester's Copy