2015_0629 � 1
C�IECK ONE:
IRRIGATION DOMESTIC � FIRELINE
BAC�'LOW PREVENTION ASSEMBLY TEST AND MAINI'ENANC'E REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: I�7� S . �°�� �' ���-�- 2� •
The bacictlow preveation assembly detaile� below has beea tested aad m�t�ed as required bv TNRCC
reeulacions aad is cerdfied w be operating within acceptable paramcters.
TYPE OF ASSEMBLY
� Reduced Pressurc Principle � Pressure Vacui�Breaker
� Double Check Valve o Atmosphere Vacuum Breaker
r�
Maaufact�aer �� � � S� ,' S
Model Number � �� �� �T Located At �Jo�*i��Rlo�\1
Scrial N�ber �_�1� ��
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V�CLTUM BREAI�R
Double Checic Va1ve Assembly
lst Cherk 2nd Chec�: Relief Valve Air Inlet Check Valve
Inival Test DC-Closed Closed Ti�ht �Q ed at Opeaed at osid
Tight, � Leal:ed o � sid osid
��o�`��l j' RP- �s.�Dsid ��j a f�
�� ❑ Did not Opea o Leal:ed �
�P�
and
Mataials
Used
Test Aft�et DC-Closed Closod Tight o Opeaed at Opeaed at __nsid
Repair Tight o �sid osid
RP sid
The above is cerrifiod to be true.
Firm Name 1-��t��t�^� C'c,nti►�-.�sc o�.i Catifiod Testa �Q�'a- �-�t-�'��
I i�o �: t e,��fA� �en$r��,�,� �F 300
Firm Address M(1=,T���.— Cert.Te.ster No. �3o I i" � D�_
c8�e � �3�d3a3G
llate last accuracy tested �- � 3-��
White - Customer's Copy Yellow - City Copy Pink-TesteNs Copy