2013_1101 (2)CHECK ONE:
IR$IGATION DOMESTIC FIRizi_irig" /"�
BACI�Z.OW PREVENTION ASSEMBLY TEST AND CE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D_ #
LOCATION OF SERVICE: � 1�S -I %ii f'j t =' t. y� L -. �� �
The baeidlow pre+reatioa assembly detailed below has been tasted and maiaRaiaed as required by TNRCC
regulations and is certified Lo lx operating within acceptable pm-ameters_
TYPE OF ASSEIt�LY
c Reduced Presstu�e Principle a Presstae Vacurmm Breakta
'�9 Double Check Valve a Atmosphere Vacuum Btsaker
n` _`� ,.
1ViatlLlfaCIISCr F t 1 ��l r" ,% S1ZC �
Model Number - r -:� � ");" t�� 1c , � Located At �� ! � � �;? #-� C_ %l_.: J"rl
Serial Number f 1; ) 1 '
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE YAC[JTJM BREAKER
Double ChKic Valve Assembly
1st Cheek tad Cheri: Relief Valve
Air inlet
Check Valve
hsitisl Test DC- Closed
Closed Tight �C
Opened az
Opened az
Tight, t]
RP- �! .� -paid
t ^�i� o
�sid
osid
Leakad O
Did not Opm c
Leaioed c
Repairs
and
Mataiais
Used
Tes[ ARer DC- Closed
Closed Tight Q
Opened az
Opened az
said
Repair Tight O
Wald
-
Wald
RP "d
The above is cxitiBed to be true. ,---,
J _ ,
Firm Naaaa `� f � .' -� � f ,. �1: ; it � Ce:tiSad Tastier ii �� _. �_.. � c t•_ - --
Fam Addttss 1�' r'. `- F � � -f Cent Tester No. � ;'� �` � i `� Dace f l -
r
Gauge * _i_.? _ C� E:• C =: � (-
Date last accuracy tested -:; - _ ;- -�
White - Customers Copy Yellow -City Copy Pink - Tester's Copy