2015_0311 C�IECK ONE: �
IIISIGATION DOMESTIC FIRELINE
BACI�'LOW PREVENI'ION ASSEMBLY TES?AND MAINI'ENANCE REPORT
x�ME oF Pws: CITY OF COPPELL
PWS I.D.#
LOCATIOI3 OF SERVICE: �D W- ��-��
The bacl�low prevention assembly detailod below has beea testcd a� maiatained as required bv TNRCC
reguladons and is certified w be operatiag wittua acceptable pa�aeters.
TYPE OF ASSEMBLY
C Reduced Pressure Principle e Pressun Vac�nmm Breaioer
�( Double Check Valve ❑ Atmosphere Vacwm Breaker
Maaufactvrer I/l�-��-5 Siu
3ly,ir
Moae1 Ivumber O�D7 M 2 Locacod At �r.e. VC�k.(-�-
s«�r►�� l 3 54( .
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Donbie Chedc Va1ve Assembly
lst Check �nd Ched: R�1i�f�alve Air Inlet Checic Vah►e
Inidal Test DC-Closed 2.0 CZosed Tight Al' Opeaed at Opeaed at �d
Ti�t .� Leal:ed 2,Z O �sid __osid
RP-_psid
�� p Did not Opea o Leai:od �
�P�
and
Mataials
Usod
Test pft,er DC.Closed Closod Tight o Ope�od at Opened at _Fsi�
�� �� p osid flsid
Rp 'd
The above is catifiod to be�we.
Fum Na�e �_�-tnn ��r� �fL� CewSed Tescc l 1 � �T��
Firm Add�.�s,�� ���c 7�17 Cert Tester No. BPOb►b651 Dste 3 1 S
Wakah�cht,2
Gauge # b�/1t�7�
Tx-
Date last accuracy tested
C�iECK ONE:
IRRIGATION DOMESTIC FIRELINS
BACI�'LOW PREVENTION ASSEMBLY TEST AND MAIIVT'ENANCE REP4RT
NAI�OF PWS: CITY OF COPPELL
PWS I.D.#
LOCATIOIv'OF SERVICE: SbC� W • f�2-�In e�
The baci�low preveation asscmbty detailod below has been testzd and maintaiaed as req�ured by TNRCC
nsularions and is cerrified to be operadng witbin acceptabk parameters.
TYPE OF ASSEMBLY
e Reduced Pressurc Principle e Pressure Vaanmm Breaker
;9( Double Check Valve o Atmosphae Vacuum Breaker
�w
Maaufacnaer GUG�S Siu
Mode1 ti�ba 77�F L.acaced At �l v'.� VQk ��-
s�N� 1087�� -
REDUCED PRESSL�tE PRL'�1CIPLE ASSEMBLY PRESSURE V�CUUM B1tEAI�R
G SS Donble CL�dc V�e Assmb�•
lst Checic �C�edr Rs�ief�ah�e Air Inlet Checic Valve
Initial Test DC-Close� ✓�•O Closed Tight A' Opmed at C)peaed at �sid
Ti�t X� � 2•S� -�
Rp-__Fsid
�� o Did me Opm t� I,c�ed a
RePairs
and
Mataials
Used
Test Aft,er DC-Closed Closed Tight o Opened at Opeaed at �sid
Repair Tight o �sid _,..,osid
Rp sid
The above is c,ertified to be tive.
Firm Name fF C-�'1'or1 �Y'.e t�.d s Catified Tate� 'l�Q�n Hc_J6T[��
Firm Address �� �7 Cert Teste No. f'�PbD I D(v51 Date��e,L.,�cS
Ll1(�xG(�C�1 Q
�c
Gauge # Ofo//D�D75
Date last accuracy tested
C�ISCH ONE: �
IRRIGATION �C DOMESTIC FIRELINE
BAC'l�Z.OW PREVENTION A�SSEMBLY TFS'T AND MAIIVTENANCE REPORT
NAI�OF PwS: CITY OF COPPELL
PWS I.D.#
LOCATION OF SERVICE: S�� W �-I-I�►Q. I —
The bacl�low preveation asscmbly decailod below has bem tested and maintained as requircd by TNRCC
re�ladons aad is cerri5ed to be operating wit6ia acceptable paramcters.
TYPE OF ASSEMBLY
e Reduad pmsure principle e Pressvn vacuum Breaiaer
,}�' Doublc Chak Valve � A�SP�V�B�
Maaufacnaer ��b[.D Size 2��
Mudel?vimnber �� Lacatad At @ ��Y" �jt'1 �/Gl.• �'�-
s�N� ��9/ss .
REDUCED PRFSSLRE PRINCIPLE ASSEMBLY PRESSURE Y4CULTM BRE�iI�R
�� Double C3ecic V�h►e Ass�bi! .
lst Chetic �nd C�ec� Re�ef�atve �1ir ld�t C6eck Valve
Initial Test DC-Closed �•� Closed Tight J�( Opeaod at Op�at �s�
Tight ❑ Leal:ed 2 20 __a�sid osid
Rp-_,psid '
� p flid eac+(�� � L� �
��
and
Mataials
Used
Test Aft,er DC-Closed Closed Tight o Opeaod at Opeaad at _,,�d
Repair Tight o esid �sid
RP sid
'I�e above is cerd5ed to be true. ;`
Firm Na�e �`�'ten�tr�. t�S�. Catifiod Testa �n ��s''C�'`�
Firm Address� a0X �7�-7 Cert.Teste No. BP11,�IGYoS I Date 3 ( ! 5
u���ac.h�e �x
Gauge # OCo //pp75
llate l$st accuracy tested 5
CHECK ONE:
YRRIGATION DOMESTIC X FIRELINE
BACI4'I.OW PREVENTION ASSEMBLY TES?AND MAINI'ENANCE REPORT
NAN�OF PWS: CITY OF COPPELL
PWS I.D.#
LOCATTOlv'OF SERVICE: S�O C�U• t`�3 -4��e I
The baci�Iaw prevmtion assembly detailed below has beea tested aad maintaiaod as requ�d by TNRCC
re�ladons aad is certified to be operating within acceptable parameters.
TYPE OF ASSEEMBLY
e Reduced Pressure Principie e Pressu�Vacu�B�
�( Double Check Valve ❑ Amiosp�eere Vacuum Breaker
Maaufacuaer wG�5 Siu
2��
Mod,ei Numba D D7 M � Located At `' 1��.� 6 c.� VCc k�-�-
Serial Ivumbu ��c Z ( �°a
REDpCED PRESSL1tE PRINCIPLE ASSEII�LY PRESSURE V�C[TUM BREAKER
I�uble C3eck v a1�e As�b1!
lst Check 2nd Cbedt Rdirf Vatve 4ir Inlet Check Valve
lniaal Test DC-Closod 1•�o Closed Tight ffi Opexd at Opeaod at �d
Ti�t J� Leal:ed /.�j ❑ �sid nsid
Rp-_,_psid
�� p Did�t Opea O Lq1►ed '�
�P�
aad
Materials
Used
Test Aftet DC-Closed Closod Tight o Opeaed at Opmod at __,,.�d
Repair Tight � nsid _osid
ltp 'd
Tbe above is cerd5ed w be true.
Fum Name�,�'-1,.,� �iYe P2�S— CatiScd Taw � '�^ �To,.1
F���'j �p,c `l g 7 Cert.Testa No.$PO�I CXv'S I Date 1 l S
u?axa I�a c.,l��¢
cguge � D(c 110075 , �
llate last accuracy tested � 3 �