2015_0910 C�iBCK ONE:
IR.RIGATION�_ DOMESTIC FIRELINE
BAC�'i.OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORZ'
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: � 3� I/V � �E`�� �� i
The bacl�low prevmtion assembly detailed below has bxa tested aad ma�nt�ed as required by TNRCC
regularions and is cerdficd to be operating within acceptable paramcters.
TYPE OF ASSEMBLY
C Reduced Pressure Principle C Pmsure Vacu�Breaker
� Double Check Valvc o Atmosphere Vacuum Breaker
��� S� l � F
Maaufacnaer I �s 1
Model Iv�ber ��� Located At �� � ✓ U
s��N�ba � 3 3 3��
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER
Double Check v alve Assembly
lst C3eck 2nd Checi: Relief Valve Air Inlet Check Valve
Ininal Test DGClosed Closed Ti;ht � Opeaed at Opened at esid
n..l����� Tight 7 ❑ Leal:ed o �sid _osid
6 RP- a_psid �i�
�;� p Did not Opea o Leal:e� o
Repairs
and
Materials
Used
Test After DC-Closed Closed Tight o Opened at Opmed at _nsid
Repair Tighi o osid _.�sid
RP sid
The above is certi6od to be tnu.
Ficm Name �� ( Certified Testa �✓a.�
���
FirmAddress PO t�!J�Z�011 Cat TesterNo. F�'���Z7ZU D� �—{D�
l�lwv - � 1 �SQ �7
(�auge # O'�0�0���-
Date last accuracy tested �"`�S '��
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy