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2014_0722 C�IECK ONE: IR.RIGATION DOMESTIC FIRELINE J� BACICF'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAN�OF PWS: CITY OF COPPELL PWS I.D. # LOCATIOIv'OF SERVICE: I 7�� � ��L � C-�� � The bacl�low preveation assembly detailed below has beea tested aad ma�n a�n� � nq�� by TNRCC reguladons and is cerdfied to be operating within acceptable parameters. TYPE OF ASSEMBLY e Reduced Pressure Principle e Fressure Vacu�Breakar � Double Check Valvc � Amiosphere Vacuum Breaka �� L2 Maaufactiaer /4-`—I Siu � Modei Iv umber L`��l �/1� Located At �t� l.�t�1�L/�- --��`-' W l4 vt i Serial Nimmber ���C���� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BRF.AI�R Double Check Valve Assembly lst Check 2nd Checl: Relief Valve Air Inlet Check Valve Iniaal Test DGClosed Closed Ti;ht Opened at Opeaed at osid Ti� eal:ed o nsid osid RP- � � Dsid �SS I,�;� ❑ Z�� Did not Opea O Leal:ed � �P� and Mataials Usod Test Afttr DC-Closed Closed Tight o ppeaed at Opmad at __flsid Repair Tight o �sid osid R.P sid ,� - ��c� Th�abo��is ceras�d to be a�,u. Firm Name // y°' � !I t��F`� ��-�YCf���tified Testa Firm Address l .r�fL�u-1'nJ � 7���7Cert.Testa Na c''U j���7 Date =�� (isuge # �GTC�Z� 5 Z C� llate last accuracy tested � ( -� ( �-- � 3 Whi.te- Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK ONE: IR.ftIGATION DOMESTIC �_ FIRELINE BAC�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT' NAME OF PWS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE: I-T I � E ���-1 �- ��`'`� �� The baci�low prevmtion assembly detailed below has beea tested aad maintained as required by INRCC rceulations aad is cerdfied to bc operating within acceptable pazamcters. TYPE OF ASSEMBLY e Reduced Pressure Principle � Pressure Vacuimm Breaker � Double Check Valve o Amiosphere Vacuum Bnal:er Maaufact�aer �� +`+T i S Siu Z� Model Number �^1 l'��l_ 1 _ Located At �w� Cc�n.,�,'��'L �Y V�4-V�t.- Scrial N�ber 2�� � �.�7 REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACULTM BREAI�R Doubie Check v alve Assembly lst Check 2nd Checl: Relief Valve !1ir ldet Check Valve Inival Test DGClosed Closed Ti,,P.ht � Opened at Opened at osid Tight ❑ Leal:ed ❑ vsid osid r�1 L �� sid �� �� �d aot Opea o L,eai:ed � Repairs �-�1 c,�� and Mataials ��� Usod Test After DC-Closed Closed Tight I� Opeaod at Opeaod at �sid Repair Tight ,j� osid _�flsid R.p Z sid 2�� �c��t� �N-�- ��D 5 T'he above is catified to be true. Firm Name '� � /�C t=vc" ��c��atifiod Testc � -7� Firm AddrGss ��!��L T� /� 7-�"`7 Cert Testa Na i3�3°7 Date���� (�auge # `�Z I�2� Date last accuracy tested �t � t�t - �� White - Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK ONE: IRRIGATION DOMESTIC FIRELINE � BACI{F'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT' Na►1v�OF Pws: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE: 17� ( � �L�-T L��� �I� The baci�low prevmtion assembly derailod below has beea tested and mainra�n� � nq� by TNRCC regulanons aad is certified to be operating withia acceptable parameters. TYPE OF ASSEMBLY C Reduced Pressure Priaciple e Pressvre Vacu�Breakcr � Doublc Chxk Valve ❑ Atmosphere Vacuum Breaker /' 1_ c� Maaufacnaer G'�-�`+`r'��S Siu �_ Model Number ���1 �C�� Located At � � �.�2}�rt;IZ- � ��C>-c-� Scrial Nimmber ��,� ""��c��� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V�CUUM BREAI�R Double Cbeck v alve Assembly ist Checic 2nd Checl: Relief Valve Air Inlet Check Valve Inidal Test DGClosed Closed Ti;ht o Opeaed at Opened at esid �. Tidit o Leal:ed � Dsid __nsid 1�i� ��sid �d aot Opea O Leal:ed � �� Cc.��t�C_n ��n�� aad Mataials �n��' �1N �v � u�a vL Test Af�x DC-Closed Closed Tight Opeaed at Opeaed at �sid Repair Tight �^ .� vsid _osid RP �� sid �T` (� Cjc� `_'��. �/� � �1C BbOVC 1S CC.C�1.f10d LO bC Lt11C. r Firm Name� * /7 �CT%��t ����� ���tified Tata Firm Address �x`(���l'�T� �����`'�Cert Tasta No. � � t�`�1���7Date�`� Gauge # ��'��I J 2 (p llate last accuracy tested /J-�r� � �7J Whi.te- Customer's Copy Yellow - City Copy Pink-Tester's Copy