2014_0529 C�iECK ONE: '
IRRIGATION_� DOMESTIC FIRELINE
BACT�LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D.#
-� ,.--� �
LOCATION OF SERVICE: ��� ��"��-�-� ����, �/, �
'Ibe bac1.-flow preveation assembly detailed below has baa tested aad II1a�ntain� � nq� by T'NRCC
reguladons and is certified to be operating withia acceptablc parameters.
TYPE OF ASSEMBLY
C Rtduced Pressure Principle C Pressurc Vacu�Breaker
�' Double Check Valve 0 Amiosphere Vacuum Breaker
�" /� � oi �
Manufactiaez �"� /�, , Siu
;� ,
Model Number �./�!/' Located At f�_ �-',� ��;�
Serial Iv�ber �/<'7� �
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER
Doubk Check v alve Assembly
lst Check 2nd Cbecl► Relief Valve Air Inlet Check Valve
Inidal Test DGClosed Closed Tig�it''�� ed at Opeaed at osid
Tight Leal:ed a Dsid osid
R.P• / '7 �sid
�� p Did not Opea o Leai:ed �
RePairs
and
Materials
Used
Test Aft�er DC-Closed Closed Tight o Opeaed at Opeaed at __�sid
Repair Tight o esid osid
R.P sid
The above is catified to be true.
Firm Name �� r�.�f , /:- `.�,<� ��.� Cetifiod Tester �� � � � <,
� Firm Address ���`r �ti 1/ ��?�•�,�,�� `� Cert. Testa No. �� �=%��'�����t�� Date i��-i�-�i y
, �
C�auge # (�i/<-u�/_'
llate last accuracy tested �,� -;,y
,--�—
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy
_ _ . _._ _ _. .. _ _