2015_0415 C�IECK ONE:
IRRIGATION_� DOMESTIC FIRELINE
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATTON OF SERVICE: S'�'� ����-�►'� C-���
The bacl�low preveation asscmbly detailod below has beea tested aad ma�nta�n� � nq� by TNRCC
regulauons aad is cerdfied to be operating within ac�eptable parameters.
TYPE OF ASSEMBLY
C Reduced Pressure Priaciple e Pressure Vacuimm Breake,r
� Double Check Valve o Amiosphere Vacuum Breaker
Maaufactiaer
� ��C�o S� �rr
� \ �
Modei Ivumber �� Locaud At h-e-��3 ✓he.(�P-✓ I � t�x�, �
Scrial N�ber
t'�����'O U �vwt rn M ��
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Double Check v alv�Assembly
lst Check 2nd Checl: Relief Valve Air Inlet Check Valve
Inidal Test DC•Closed Closed Tight � Opeaed at Opened at esid
�—IO-lS� Ti��� � L�`� ❑ ---Dsid _osid
R.P-�sid Z��
�,�C�( � o �a not o� o t.�:�a o
��
�
Mataials
Used
Test After DC-Closed Closod Tight o ppcned at Opeaed at _nsid
Repair Tight o �sid __,Dsid
R.P sid
The above is catified to be true.
Firm Name Cedfied Testa ���-�T"`��i�
Firm Address � dg(Z�?�lr� Cat Testc No. �.#'�D�Z�l.� D� - ('�«—��
N1UW - 7 Sa Z�
(3auge # _��0�1(��b Z
Date last accuracy tested �� -l�
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy