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2015_0211 � f � pZ C�IECK ONE: IRRIGATION DOMESTIC � FIRELINE BACI4'l.OW PREVENTIO�ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PwS: CITY OF COPPELL ° PWS I.D. # LOCATION OF SERVICE: ��`� W f��,� t �� �� T'he bacl�low preveation assembly detailed below has beea tested and II]�Ztain� � nq�� bv TNRCC regulations aad is cerdfied to bc operating within acceptable paramcters. TYPE OF ASSEMBLY ,� Reduced Pressure Priaciple ❑ Pressure Vacui�Breaker . . � ❑ j Atmosphere Vacuum Breaker _.� ,,�D°u�le Check Val� -�-� ,.� ,, _� .. _ _��LL_ � __�_�--= - 3- ��,_�,__ r��:. _ . � , . . Maaufactzaer W G � , � Siu :� Modei Number t�U G vn 1 _ Located At �. W��c � �• C ►� � r i-� � ���, Scrial N�ber � L� � `► �' � _ REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V�CUUM BREAI�R � Double Check Va1ve Assembly lst Check 2nd Checl: Relief Valve Air Inlet Check Valve Initial Test DGClosed Closed Tight a1 Opened at Opened at nsid � Ti� `�� dP Leal:ed o Q o ��• sid osid � �`;C.��`� Rp__�.Lpsid �''� I,�;� p Did not Opea O Leal:ed � RrPairs aad Materials Used ... =-_ - . _ .r..�__=_ �. __ , A ; �_ ,_.: >: ; - -�;- _ -_ . . -� - _ _ , _. _ � �Tast Afte'r DC-Closed Closed Tight o Openod at Opeaed at �sid � Repair Tight o esid osid RP sid The above is catified to be true. �t� � Firm Name �!�T�b.�, C'• -c.. Celtifle$Testet 1 �UJ c-� .r. c L�.l�N n r� Firm Address �d �v�r 7�i � Cat Tester No. �ur�5°!J� Date a l �r 1 i j ; �G r�G,�.-.� e.. < T l` 7 7 /G� Gauge # (� 3 U$JJ 1� Date last accuracy tested 3 /��� White- Customer's Copy Yellow- City Copy Pink-Tester's Copy _ , _ _ _