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2015_0508 (4)
C�IECK ONE: IRRIGATION DOMESTIC � FIRELINE BACKFI.OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE: f�t � 75D C��v t�n �s�y�l � "�� "l�� i�j The bacl�low prevmtion asscmbly detaile� below has beea tested aad ma�nta�n� � nq� bv 'I'NRCC reguladons aad is ctttified to be operating within ac�eptable paramctcs. TYPE OF ASSEMBLY ❑ Reduced Pressure Principle ❑ Pressure Vacui�Breaker �--- Double Check Valve o Atmosphere Vacuum Breaker Maaufacwrer ����.� Size � � � Model Number ���1 /�'� � Located At W�1�'S ' �1L f�t j' �C i.�u ;� r����f�•' Serial Nimmba ���� � REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Check v alv�Assembly lst Check 2nd Chec�: ReIief Valve Air Inl�t Check Vaive Initial Test DC-Closed Closed Ti,,A.ht Opeaed at Opened at �sid l Ti� � Leal:ed ❑ osid _osid �-�P� -!.j R.P-�sid I,eal:ed � , �� Did not Opea o Leal:ed o R�Pairs and Mataials Used Test ARet DGClosed Closed Tight o ppened at Opeaed at _�sid Repair TighL o nsid nsid RP sid The above is cerafied to be ttve. Firm Name ��4 �� �'C-������ �� � _ Certifiod Testa � ► � � i e�r1��T �� �,t��.� S/° � F�Aaa� �� �:��5 L�� �� ��� c�.r�xo., ��� r�__, n� ���-l�-� � _ '{„s VC�n C �t , �`�. 1 1( �r'`ri b JC' c�auge # ,(�.�/��o� 1 � llate last accuracy tested � �'" � '� ' � White- Customer's Copy Yellow - City Copy Pink-Tester's Copy