2013_0605i:1i 1, G A T, : (D R11 G, 3,P.HES 7PEC FM i EKIE
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NAN2 OF PWS: CITY OF COPPELL
PW .0 S I.D. "
LOCATION OF SERVICE: c) 1 � \
The back2ovr przv=tion asserably detailed below has been tested and mainuired, as requintd by -jNRCC
rc2ulazions and is c.-rdfied to be operating within acceptable par=e=.
C Rcduc-nd P=s= Principle
C2 Double Check Valve
Manufacturer
Model Number
Serial Ntumber
TYPE OF ASSEMBLY
C Pressure Vam= Brczl=
0 Atmosphere Vacuum Breaker
size
Located At
The above is ccrt.L6ed to be true.
c,
Firm Nate A
dZed TC=
FL= Add=--z INC.
c)
-
7
1 ul C, -e 1#1 1 ,
a