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2014_0529 i m, . ,em, � — , p�{ �. � , �; .Ar �., �-, ,. � � . � . k � � . . � � . .. . �� F I C�IECK ONE: IR.RIGATION ��,.�� DOMESTIC ` FIRELINE' � , � BACKF'LOW P�tE�ENTION A55EMBLY TEST AND NiAINTENANCE REPURT ; rr�.n�oF PwS: CITY OF COPPELL ` ; FWS I.D.# � i � , � LOCATI�N fJF SERVICE: �� f�'``��,�r r� �.� � Tlie bac}�low prevcatioa' assembly datailed below has bxu ttsted and maintained as requirai by TNRCC' reeulazions aad is cerdfied t�be operating withia acccpcable paramtters. TYPE OF ASSEMBLY C R�ducad Pressurc'Frinciplc � Pressure Vacvum$reaker ; �� "�� Double Check Valve �� a �� Atmosphcre�Vacuum Breaker ; � � ; �'"'',r.� � Size � � � I Manufact�ser �.� i � � �.� � , � � Modei Ntimaber � r�`��.� � Lacaud At ��'�.��" ,'�fs.-�„`�'� � � � � l ��:��"� _ s��N�� I R�DUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V 4CL1UM BREAKER +, � ` Dauble Gheck�%alve Assembly ; 'lst Check , 2nd Check Relief�alve Air Inlet Check Valve j � � f Initial Tcst DC-Clascd � Closod 7i;hf��- �pened at � OPeaed at osid � Tisht e--� �,eal�:cd ❑ psid �.psid ; Rp- � `� nsid , , � f �� Leal:ed o � � � I?id not Opea o Leal:ed ; { � RePairs � � and � � � � I Materials _ � , Used ; Tast Aft,er DC-Closed Closed Tight o Opencd at Opcaod at osid ; Aftar j Repair Tight � �sid _,�sid ; � � Rp sid i � The above is cercified to be wc. ` ; � Fum Name �� ;� ,,,,,�,� Cestified Testa �r- ,/ ��. _f., ` ` �� ; Firm Address,,,��>�.� [ �. ��: .' �.r��r��:�� w°'�' Ccrt,Tester No.r�:�`'�W��<��=;� " Date ' .. Y d �� .. .. . � .. � ra (3auge # �-��.�`'��'G-��-� i Date last accuracy tested ` ��j-a�� , � � White-Customer's CoQy Yellow -City Copy Pink-Tester's Copy i