2015_0320 C�IECK ONE:
IRRIGATION�_ DOMESTIC FIRELINE
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NA.N�OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATIOIv'OF SERVICE: ��II �Y�(ti�l� %� 1
The bacl.�flow prevmtion asscmbly detailed below has bxa tested and maiatained as required by TNRCC
reguladons aad is ceraified to be operating within acceptablc paramtters.
TYPE OF ASSEMBLY
C Raiuc�Pressure Principle C Pressvre Vacuimm Breaker
� Doublc Chxk VaIvc a Atmosphere Vacuum Brealer
Manufact�er ���_; � Siu
���
Model N�ber �J� Locatod At ,,.� ��p
s��N�ba ' c��3i�`
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Double Chetk Valve Assembly
lst Check 2nd Checl: Relief Valve Air Inlet Check Valve
Inidal Test DGCloscd�i� Closed Ti;ht � Opcaed at Opeaed at esid
Tisht �, Leal:ed nsid osid
R.P-_psid -� '
�;� p G'-� Did aot Opea o Leal:ed �
�P�
and
Mataials
Used
Test After DGClosed Closed Ti,Qht o Opeaed at Opmed at osid
Repair Tight ❑ osid osid
RP sid
The above is certifiod to be true.
Firm Name :"� Aocuracy�ackflow Catified Testa��'l U�Y'1 �r/f�U�l�
a on irc e �
Firm Address Friseo,TX 75035 Cat Taster No. Date � �� . �!-,
(3suge # � '
llate last accuracy tested � ' � �
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy