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2015_1015 C�IECK ONE: IRRIGATION DOMESTIC FIRELINE BACKFi.OW PREVENTION ASSEMBLY TEST AND MAINI'ENANCE REPORT NAME OF PwS: CITY OF COPPELL PWS I.D.# LOCATIOIv'OF SERVICE: j{°�'��:�t L-�'�� � The bacl�low prevmtion assembly detailed below has beea testod aad maintained as required by TNRCC reguladons and is cerdfied to bc opera�ng withia acceptable parameters. TYPE OF ASSEMBLY e Reduced Pressvrc Principle C Pressurc Vacu�Breaker :�` Double Check Valve ❑ Amiosphere Vacuum Breaker � Maaufact�er ` .c�. ��- ��` ,'��% $� �'`�'`� .�- Modei Number J`�� Located At ;�F, �,` ' . • �r�',';k'•� � � Serial Ni�ber ,a'. `� `i` � � £'-' -� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSU,�tE V�CUUM BREAI�R Double Check Valve Assembly � lst Check 2nd Checl: ReIief Valve Air Inlet ' Check Valve Inival Test DGClosed Closed Ti;ht e- Opened at Opeaed at esid Tight ; � Leal:ed ❑ Dsid _osid RP �t sid ,:�, / �;� p Did not Opea o L,eai►ed o �P� aad Materials Usod Test After DC-Closed Closod Tight o Opeaed at Opeaod at �sid Repair Tight ❑ �sid __nsid R,P sid The above is catifiod to be t:ve. . , Firm Name ' 'f _,%'_-�� ,t �Certifiod Testa �. ���% �,,���. � �, - � , . <.,,��,„��. c� �- �. �" �� �,���.__ _ r,., � .. r ^ � - , , ., Firm Address ���.�' �°'j�'� -�'` Cat Taster No ` `� ��` Dater< =�= Gauge #,%;(�✓-�,���.r -�i llate last accuracy tested r/`1��1 11 i '� White - Customer's Copy Yellow - City Copy Pink-Tester's Copy