2015_0413 C�IECK ON�E: �, '1 '.,. . .. . . ' " " �
IRRIGATION DOMESTIC � FIRELINE
BACI�'LOW PREYENTION ASSEMB�Y TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D.#
_ �
LOCATION OF SERVICE: I � % `� � � ;� ; _�, �- ;,��_
The bacl�low preveation asscmbly detailed below has baa tested aad maintain� � nq� by TNRCC
regulations and is cerdfied to be operating within acceptable paramcters.
TYPE OF ASSEMBLY
�____ Reduced Pressure Principle C Pressurc Vacu�Breaker
^ Double Chec�"Valve o _ Atmosp�ere Vacu�mm Breaker
r .
r f
Maaufactzaer � � ��; � � $iu �
- -- -
, , .
' (:^ "� � ,�.���.f-�-, P--�a C G,:� >C" ,
Model Iv�ber �- Located At
Serial Nimmba � "1 '�- `� 3�� �
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER
Double Check v alve Assembly �-- �� tf' �
�� �
lst Check �nd Checl: Relief Valve Air Inlet Check Valve
Ininal Test DC-Closed Closed Ti�t ed at Opened at osid
Ti�t � d Leal:ed o . ��psid nsid
� r d .i �„ RP-v��sid
I,�;� ❑ Did not Opea o L,eaiced o
�P�
aad
Materials
__ . _.
Usod
Test After DGClosed Closed Tight a Opeaed at Opmod at �sid
Repair Tight o nsid ^_osid
R,p sid
The above is certifiod to be true.
Firm Name %Y I"��`� � � �!`/� Cettified Testa �'� �.`%''�L ��✓S�'�'v'
Firm�ddres.s �-l3 /�; ✓:;%',:�C�i�lt;%4,.,�% CatTesteNo. ,1✓���/>�(� Date � .-` t-�'(`7 _
�—, �
� ;i..':j���-( � �", J•�l C'i �
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(Gauge � ;�`1 !1��
llate ]ast accuracy tested ` 7 � d "�
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy