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2015_1002 _ '� C�IBCK ONE: �,.. LRRIGATION I-/ DOMESTIC FIRELINE BACIC�Z.OW PREVENTION ASSEMBLY TEST AND MAINI'ENANCE REPORT NAME OF PWS: CITY OF COPPELL ; PWS I.D.# LOCATION OF SERVICE: �''�� ' � x;�-� r�-1�� L% The bacl�low prevmtion asscmbly detaile� bclow has beea tested aad ma�nra�n� � nq�d by TNRCC reeulations and is cerdfied to be operating within acceptable parametreers. TYPE OF ASSEMBLY C Reduced Pressuie Principle ❑ Pmsure Vacui�Breakez � Double Chcck Valve o Atmospherc Vacuum Breal:er � Maaufac�aer i,�,�`��. � +��,��` Siu � .�._ Modei Number .�-'`�U Locaud At �" ��'u�v � �;/,/�c'I x,`� �� J � � Scrial N�ber �7 `~f "� � ----- . . ___ .,_ . � REDUCED P�SSURE�'RINCIPLE ASSEM�LY - PRES�i�RE VACU�JM BREAI�R , t �� Double ChecCc Va1ve Assembly 1, lst C3eck 2nd Checl: Relief Valv� Air Inlet Check Valve Initial Test DGClosed Closed Ti�t Opened at Opened at osid - Tight,�'t� ?, Leal:ed ❑ osid osid ` RP-_psid �, � L,�;� p Did not Opea o Leal:ed � �P� and � Materials Used Test Aft,et DC-Closed Closed Tight o Opened at Openod at __nsid Repair Tight ❑ flsid osid RP sid The above is cerrifiod to be we. - .� , �, ;��F�. � ' 1 S ,; _�._ �K�',� Certified Testa '' � _ -`'' ? . Firm Name �� ;; L., j.-� �� ..-_ C�C.>��-`''��''��.��.Jr= J�Cat Testc No. �:��`=� �� Date�� ? ' � Firm Address Gauge ��-�}�a:,,�L-� / (�, `�� `? Date last accuracy tested `� / •' j White- Customer's Copy Yellow - City Copy Pink-Tester's Copy