2015_0326 C�IBCK ONE:
IR.RIGATION DOMESTIC FIBELINE �
BACI{FZ.OW PREVENTION ASSEMBLY TEST AND MAIIVTENANCE REPORT
N,�ME OF Pws: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: �� � �r�`� i�1r
The bacl.�tlow prevmtion asscmbly detailed bclow has beea tested and maintained as required by TNRCC
regulations and is cerd5ed to be operating withia acceptablc paramcters.
TYPE OF ASSEMBLY
c , Reduced Pressurc Principlc C Pressure Vacui�Breaker
� Double Check Valve � Amiosphere Vacuum Breal:er
t�
Manufacturer ��-� Siu �
Model Number '7� � Located At �/�r� �� e� f b� �'�`� `
s��t N�ba /�`a fl 1u� a.�c�,
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACULTM BREAI�R
Double Check Valve Assembly
lst Check 2nd Checl: ReIief Valve :,ir Inlet Check Va1ve
Inidal Test DGClosed Closed Ti;ht Opcaed at Opeaed at nsid
Ti�t_ �`� � Leal:ed 'd�v o nsid osid
Pass �__ps�a �
�;� ❑ Did not Opea o Leal:ed �
�P�
and
Materials
Used
Test Af�er DC-Closed Closed Tight o Opeaed at Opmed at �sid
Repair Ti,Qht ❑ �sid osid
R.P sid
The above is catifiod to be t:ue.
Firm Name �J SS F�r�-����r��'�� c«�s�a r� j�•.���1�'t-Q�'�:�
Firm A��*��,.��?Q� Nd���r•.e•-�. ��� Cert. Testc No ����Z�� Date�`��''���
Gauge # ('�0� � ���
llate last accuracy tested r�' � �" �y
White - Customer's Copy Yellow - City Copy Pink-Tester's Copy
C�IECK ONE:
IRRIGATION DOMESTIC FIRELINE �
BACI�I.OW PREVENTION ASSEMBLY TEST AND MAINI'ENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: _�D � /�� r �. i IN �' � i/`�
The bacl�low preveation asscmbly detaile� below has bxn tested and maintained �s required bv TNRCC
regulations aad is cemfied to be operating within acceptable paramcters.
TYPE OF ASSEMBLY `
C Reduced Pressure Priaciple ❑ Pressurc Vacu�Breaker
� Doublc Check Valve � Amiospherc Vacuum Breaker
ri
Manufacturer �o�•�-� Siu 3f�ts
Model Number C'�D'1 l� � Located At ��'���- O�► �" �O y P'o cLG��+
Serial N�mmber Jt�O_i���1I�
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VAC[TCTM BREAI�R
Double Check Valve Assembly
lst Cherk 2.nd Checi: Relief Valv� Air Inlet Check Valve
Inival Test DGClosed Closed Ti�ht o Opeaed at Opened at osid
�i� �-t- Tidit o Lcal:cd o osid osid
RP-_psid
-��'�-. �;� ❑ Did not Opea o Leal:ed o
Repaits /�►'1.ur� � c�/` '"�'Q t.G�-� !'y Yv�c��C'r ���w�s � S v�,c�� u�.
M�aLs �� 1 1 �:..�� -�-�� � ►�� �- c..l eQ fl s fi
Used
Test Aft,er DC-Closed Closed Tight o Opened at Opeaed at _nsid
Repair Tighi ❑ �sid osid
RP sid
The above is certifiod to be tnu.
Firm Name � �� ���'� rP`�C�`-� ��f• Cettified Testet ,�1/' `�+"a1►� ��/���v�;S
Firm Aa�m�.b D� �c�i'v,✓+� P��'��e Cert. Tester No.� (�3��'� Date 3..Z.b-`�
t�auge # ��l��8 l�� 7
llate last accuracy tested {a-��c '1 y
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy