2015_1102 C�iECK ONE:
IRRIGATION „-'` DOMESTIC FIRELINE
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATTON OF SERVICE: -
The bacl��low preveation assembly detailod below has beea tested aad r*+?�ata�ned as required by TNRCC
reeulauons and is cerdfied to be operating within accrptablc paramcters.
TYPE OF ASSEMBLY
e Reduced Pressvrc Principle � Pressurc Vacu�Brealcer
o�'� Double Chcck Valvc O Amiosphere Vacuum Breaker
Maaufactsaer �-�.�� � Siu " ��`�
Model Number °- " Located At f`� . -`; ��� ,.� � �`, �� ��
Scrial N�ber �� " ° �'���
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Doubie Check Valve Assembly
lst Check 2nd Checi: Relief Valve Air Inlet Check Valve
Ininal Test DGClosed Closed Ti�hht t� Opeaed at Opened at nsid
Ti�t�,<:� �' Lcal:ed ❑ �sid osid
RP-_psid � ,�;.
�;� p Did noc Open � Leal:e� �
�P�
aad
Materials
Used
Test After DC-Closed Closed Ti,ht o ppeaed at Opeaed at __nsid
Repair Tighi O �sid ___..,osid
RP sid
The above is catifiod to be true.
�'�� i ' r� � _ /�;yt ,�'�� ' �'�C..�
Firm Name .. Catifiod Testc �': �' , f - f' `F
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: � � .- �, � _
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Firm Addness � ��.���� ` ����� Cert. Tester No �`�- �'f=� Date�� ,�'� � �� �
, _
(�auge # ��t.��_ �� ,�� s�r . �-<
llate ]ast accuracy tested '�- 3
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy