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2015_0605 C�IECK O1�E: ° IRRIGATION DOMESTIC �'` FIRELINE BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT' ; NAME OF PWS: CITY OF COPPELL � , � PWS I.D.# J i LOCATION OF SERVICE: ��b S. '��l� �-Qi� ;�� P-'�,f�� � � The bacl�low preveatioa assembly detaile� below has beea tested aad maintained as required by TNRCC re_$uladons aad is ce:tified to be operating within acceptable parametecs. TYPE OF ASSEMBLY f�, Reduced Pressure Priaciple e Pmsurc Vacu�Breaker , � ., _,._��_-K _� ,,., � Doubic C�xk,VaIve _ o Amno�phere Vacuum Breaker Manufact�uer 1,���k�`�/s Z �n•`� Siu �,� � �5` x� � Model Number L.ocated At ���-s�� f�i`'o� Serial N�ber ����Z 7�� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R ; � Double Check v�lve Assembly ''� _ lst Check �nd Checl: Relief Valve Air Inlet Checic VaWe +, y Ininal Test DGClosed Closed Tight � Opened at Opened az _osid ; Tight �- Leal:ed �sid _osid RP-�psid y-�, � � , " I,eal;ed o Did not Opea o Leal:ed � �� and , Mawials _ . ,,. � Used a „ _ , � ,.. . ; . - Test After DC-Closed Closed Tight o Opeaed at Opmed at _�sid Repair Tight o �sid esid RP sid The above is cerdfied to be�ue. � . Firm Nam�e �...�.��<:� � , �t/� �� :" CertiS�ed Teste . � -.���`�i �"`' ' y ': Firm Address �� � ;,�✓ ��, - ,�� . 1�� Gat T�ter No. �``���'y �rs% ` Date .� /> ; r��. �/� �` ,, , , e Gauge # p�.�/b �� . llate last accuracy tested y ;c �/ White- Customer's Copy Yellow - City Copy Pink-TesteNs Copy .,_._._., ._,.�... ....._.. . . .___., . _.__.. . _._. ... __. _ . _ _ , _ _ .. -- ,_ I _