2014_0715 CIIECK ONE:
IRRIGATION DOMESTIC ✓ FIRELINE
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. # a !
LOCATION OF SERVICE: S c ( I Q LI + p n C
The backflow prevention assembly detailed below has been tested and rnainraiiied as required by TNRCC
regulations and is certified to be operating within acceptable parameters.
TYPE OF ASSEMBLY
C z Reduced Pressure Principle c Pressure Vacuum Breaker
Double Check Valve Atmosphere Vacuum Breaker
Manufacturer W f't S Size r r
Model Number t-- Q Q 7 1' QT Located At fv1� +�� / IrL W . C n rnF V p 1 � {�
Serial Number (DI() o e oZ
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER
Double Cheek Valve Assembly
1st Check 2nd Check Relief Valve Air Inlet Cheek Valve
Initial Test C-Clos 1. g Ea
. fit o Opened at Opened at
Tight— osid
Tigh rzf LeSk O o osid _osid
--PF) `Ssec, RP- psid
Leaked Did not Open o Leaked J
Repairs
and
Materials
Used
Test Ages DC- Closed Closed Tight o Opened at Opened at osid
Repair Tight o osid osid
RP psid
The above is certified to be true.
Firm Name I, i S Ln e l Ar bc� /i v . r _r,c certified Tester
Firm Address 9 Cert. Tester No. Z Z 5Z2 Date 7 - 1 F/i � - /-
Le (A) r_S v ;1 k�, - T5(
Gauge # �1 � Sj l n 1 {
Date last accuracy tested - - 5 - fz4
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy