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2014_0715 C�IECK ONE: IR.RIGATION p/°�w DOMESTIC FIRELINE BACKFLOW PREVENTION ASSEMBLY TES?AND MAIIVTENANCE REPOR? NAN�OF PWS: CITY OF COPPELL PWS I.D. # r LOCATION OF SERVICE: � � � ��--n �1 ��'� �;�� v .,i' ti,_ o-._�� The bacl�low prevmtioa assembly detaile� below has beea tested and ma+ t�ed as required bv TNRCC reguladons and is cerdfied to be operating within acceptable paramete:s. TYPE OF ASSEMBLY e Reduced Pressure Principle C Pressure Vacu�Breaker ,_„� Double Check VaIve ❑ Atmosphere Vacuum Breaker � Maaufact�aer �-- � � �� ,��. ,�, S� 1,�, Model Ivumber (�' '�'� Located At �`r� ,, �, �''{'' � �' . , , ,:. Scrial N�ba ' �r � REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V�C[}UM BRF.AI�R Doubie Check Valve Assembly lst Cherk 2nd Checl: Relief Valve Air ldet Check Valve ' Initial Test DGClosed : �-- Closed Ti�,ht`~ Opened at Opeaed at �id Tighi Leal:ed o �sid _�osid RP-__psid �;� p Did not Opea o Leaked � RePairs and Materials Usod Test Aftet DC-Closed Closed Tight o Opeaed at Opeaed at _�sid Repair Tight 0 esid ,_osid R.P sid � ..� The above is catifiod to be true. r � �. � ,-. , :� Firm Name �, . � �''" ' � Certified Testa �,�'' "��> '� �_ - � � ,,., , ,�,;: -� Cert.�Tester No. ° .��-��,,; , ,. ;�,; Date ,�' �� .� � :�:�-;:�' _ Firm Address�" '' �- (�auge # ` ,� . . Date last accuracy tested "F ,r' White - Customer's Copy Yellow - City Copy Pink-Tester's Copy