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2015_0508 (2) C�iECK ONE: IRRIGATION � DOMESTIC FIRELINE BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPOR? N�oF Pws: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE: �'�'�..`� �l�C} �u Y�� I��'R �'��c^�? i I 1 1� `�:�'G' � `7 The bacl�low prevtntion assembly detailed below has beea tested aad maintained as required by TNRCC regulauons aad is certified to be operating within acceptable paramcters. TYPE OF ASSEMBLY C Reduced Pressure Principle � Pressure Vacu�Breaker �"' Double Check Valve o Atmosphere Vacuum Breaker � l� Maaufactiuer ,��.��t-���� Siu � � � , ; . '��t�� !��-�-�r -�1-, c��'s vte'��.�.1 � ��" �� ��. Model Number �..��% � � Located At ;/ Serial N�ber J° � �\�`t REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Check Valv�Assembly lst Check 2nd Checl: Retief Valve Air Inlet Checic Valve Initial Test DGClosed Closed Ti,�ht Opened at Opened at nsid Tight Leal:ed o _�sid _nsid � . �� - ��- sid , f•� ` �� � �;� o � Did not Opea O Leal:ed ❑ RePairs aad Mataials Used Test Aft,er DC-Clased Closed Tight o Opeae�at Opeaed at _�sid Repair Tight o osid __osid RP sid The above is catified w be tnu. ^� , �y ,, ,. �t Firm Name�° �,K �C.�r",t �t �;��i I Cettifiod Testa W i �� � 4-t Y`�-i t�.. l.t 1��.� `� X � � � � , � ,,. Firm Address���"� ��^•r� `��fi`� Cert. Testc No. �� � '�"� � Date � _ l;�" ���^C:,�/'�i� � � f l '�' �"/.�. '��t`` ( ,_�� Gg� � �--�I P {�t� � o� �,_ llate last accuracy tested ,� "" ' � White - Customer's Copy Yellow - City Copy Pink-Tester's Copy