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2015_0326 C�IECK ONE: IRRIGATION DOMESTIC FIRELINE BACI�Z.OW PREVENT'ION ASSEMBLY TEST AND MAINTENANCE REPORT NAIv�OF PWS: CITY OF COPPELL PWS I.D.# LOCATION OF SERVICE: •�� r`/�Io��'— �n" The baci.�flow przveation asscmbly detaile� below has beea tested 3ad ma�ntain� � nq�� bv TNRCC regulacions aad is cemfied to be operating within acceptable paramcters. TYPE OF ASSEMBLY ❑/ Reduced Pressure Principle � Pressure Vacui�Breaker � Doublc Chxk Valve � Amoosphere Vacuum Breal:er �� Maaufact�er I.t�l1t..� Siu ��`� Model Number Df� ��— Locaud At f0�t-J l�'2��+C�e eF��!'��y / Serial Nimmber /lD'� ��b/� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACULTM BREAI�R Double Check Valv�Assembly lst Check 2nd Checi: Relief Valve :�ir Inl�t Check Vaive Iniaal Test DGClose� Closed Ti� t, Opeaed at Opened at osid Tisht �r F3 Leal:ed ►� o nsid osid �� Rp-_,psid �;� o Did not Opea o Leal:ed � �P� and Materials Usod Test After DC-Closed Closed Tight O Opened at Opeaod at nsid Repair Tight ❑ nsid osid R.P sid The above is certified to be we. Firm Name�� 'G�'�'.�'�-��►`'G' Certified Testc IA�°�`�a d'1 /1�a�.JttiS Firm Address�� N°-�"�"z� P�� Cat Tcster No.�POf�D 3�� Date � ��0�1� t3auge # �� 17 �! 7 llate last accuracy tested )a' 16�"�`� White - Customer's Copy Yellow - City Copy Pink-Tester's Copy C�iECK ONE: IRRIGATION DOMESTIC FIRELINE � BACKFLOW PREVENTION ASSEMBLY TEST AND MAIIVTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE: �D�v ��'' �"�'�' �r' The bacl�low prevmtion assembly detailed below has beea tested aad maiatained as required by TNRCC regularions and is ccrdfied to be operating within acceptablc paramcters. TYPE OF ASSEMBLY ❑/ Rcduccd Pressurc Principlc ❑ Pressurc Vacu�Breaker �� Double Check Valve ❑ Atmospherc Vacuum Breal:Gr � t, Manufact�aer ,/Va-� Siu Model Nt�ber `7�y Located At ��l"�'L��C�3� �i7�� /'��7. / Scrial Nimmber ;�/� D�a l�- Q-�� • REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACULTM BREAKER Double Check Valve Assembly lst Check 2nd Checi: Relief Valve Air Inlet Check Valve Iniaal Test DGCIos Closed Ti,�Q t Opeaed at Opened at osid Ti�t �'� Lcal:ed �`� a �sid osid Pra�S" �__ps�a r.��a o �a na�oP� o r.�:�a o �� Mataials Used Test After DC-Closed Closed Tight o Opeaed at Opeaod at _nsid Repair Tight ❑ osid vsid R.P sid 'I1ie above is certified to be true. Firm Name Q�'~� Fi h'`'��a�.�l-��• Catifiod Testa f•fi;�1�iQ/!�/•�-il��''� Firm A��*•.��(ooa� �n�-I Place Cat Tastallo. d�� Date �"o��'/� Gauge # �.S D� ��`r llate last accuracy tested ��'`(v'�� White- Customer's Copy Yellow - City Copy Pink-Tester's Copy C�iECK ONE: �r IRRIGATION DOMESTIC FIRELINE r� BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # LOCATTON OF SERVICE: 3�� '��"�""� ��` The back�flow preveation asscmbly detailod below has beea ttsied aad maint�n� � required by TNRCC rogulauons and is certified to be operating within acceptable paramcters. TYPE OF ASSEMBLY C/ Reduced Pressurc Principle e Pressure Vacui�Breaker �' Double Check Valve � Amiosphcre Vacuum Breal:er r� Manufact�er �� Siu $ Model Ivumber 7�`� Located At VG�-tJ l�' W�b�� "rty. Scrial N�ber ��a-`� Q�`'�� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER Double Check Valve Assembiy lst Check 2nd Checl: Relief Valve Air Inlet Checic Valve Ininal Test DGClosec� Closed Ti� Opeaed at Opened at nsid �� Tisht a'' Lc,al:ed � a vsid osid M R.P-_psid �� ❑ Did not Opea O Leal:ed � �P� and Materials Used Test Aft,er DGClosed Closed Tight o ppeaed ai Opmed at __�sid Rtpair Tight o nsid osid R.P sid The above is catified to be t:ue. p�",� Fi'rQ-�'�� A��C�iT"i�►�-�� Firm Name � �- Catifiod Testa �, Firm A��*��` �O�J�a(�c�,�rc-� ,�I� Cat Tester No Date "�-6�� (�auge # �� ti 7�� llate last accuracy tested 1�"��'�y White - Customer's Copy Yellow - City Copy Pink-Tester's Copy