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2014_1103 �r � (;�IECK ONE: IRRIGATION DOMESTIC ' FIRELINE � BACKFLOW PREVENTION ASSEMB TEST AND MAINTENANCE REPORT � :� rraME oF Fws: cITY oF coPPELL 5��,��� �;r.i� , PWS I.D. # LOCATION OF SERVICE: ✓T5 W�•�JI C�F�1kF L � The bac�low preveation asscmbly detaile� below has beea tested and maintained as requir� by TNRCC rceulauons and is certified to be operating within acceptable paramtters. _ ' TYPE OF ASSEMBLY c e Reduced Pressure Principle C Pressurc Vacutmm Breaker '�7( Double Check Valve ❑ Amiosphere Vacuum Breaker � �� f' Maaufact�er ��s Siu Modei Iv�ber �"�'� �t� � Locaud At ` ' � Serial Ni�ber �� J��� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V:�CUUM BREAI�R Double Check v alve Assembly lst Check 2nd Checi: Relief Valve Air Inlet Check Vaive Initial Test DGClosed Closed Tight )d Opened at Opeaed at � nsid Tight �( Leal:ed ❑ _�sid osid � RP-�sid � � �f`j L,�;� ❑ Did not Opea o L,eal:ed � �P� and Mataials _ Usod Test ARec DC-Closed Closed Tight o Opeae�at Opme�at __nsid Repair Tight � �sid _osid RP sid � The above is cudfied to be true. r � � _ Firm Name��� C,�:;�z �T'( Cetified Testa � - Firm Address � ���tx� Cat Taster No. �' (o Date �I Gauge # o�� �� llate last accuracy tested �I O DI White- Customer's Copy Yellow '- City Copy Pink-Tester's Copy z C�IECK UNE: f IRRIGATION �' ' DOMESTIC FIRELINE ; . . . � . � � . a, � . . � . . . � . . � . . . . � � . . � . � . . � . -� . � � . .. ., � � :r _ . . . . ..� . , .. . . . . , � i BACI�3.OW PREVENTION ASSEMB_Y TEST AND MAINTENANCE REPORT ;� � CITY OF COPPELL �� ; , NAME OF PWS: to2 Gt�::�11F� ° :; ; PWS I.D. # � LOCATION OF SERVICE: �� Vv�S� �T� C �-OD� The bacl�low prevmtion assembly detailod below has baa tested and IIk1*�La�nCd as requircd by TNRCC regulations aad is ceroified to be�perating within acceptable paramcter�. . -. - : �� . ..,,, . ,'i"1'PE 4F ASsEi�fBLY,,. . ..,: � . . �- . _� � :� ,�- �. �, , � � C Reduced Pressure Principle e Pressure Vacu�Brealcer ' a `.� Double Check Valve ❑ Amnosphere Vacuum Breal:er ��J:� 3�� �' Maaufact�uer F� Siu � � ( � �� M� LocatedAt T11� �`�-� % � Model Number ����Z / a Serial N�ber { `" � � REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R � Doublr Check Valve Assembly , ; lst Check �nd C3ecl: Relief Valve Air Inlet C6ecic Valve Inidal Test DGClosed Closod Ti,Pht 1� Opeaed at Opened at _osid Ti,ht � Leal:ed 0 �sid nsid RP- �'b Dsid � �,�;� a �•g Dia noc Opea � I.eal:ed o RePaus a� .. . � :. ., ; � `MataiaCs . - .. . _ ,_ _ � . . ,. r.-- . _ _. - , � .�.a' , �,: i Used Test After DC-Closed Closed Tight o Opeaed at Opmad at _�sid Repair Tight � �sid �osid RP sid ." � The above is certifi�to be true. � �Firm Name ' �" ���� ��� Certified Testa ��E Firm Address ��'�I= Cert Tester No.`���� Date k( � � �g� � 1�a�o1 llate last accuracy tested 1� ZD �f � White- Customer's Copy Yellow - City C�py ' Pink-Test�r's Copy ;