2015_0422 C�IBCK ONE:
LRRIGATION DOMESTIC FIRELINE
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: r:r �Jr
The bacl�low preveation assembly detaile� below has beea tested aad maintained as required b�, TNRCC
re_¢uladons aad is certified to be operating within acceptable paramtters.
TYPE OF ASSEMBLY
e Reduced Pressvre Priaciple � Pressur�Vacuimm Breaker
Doublc Check Valve ❑ A�nosphere Vacuum Breaka
Maaufact�er �c�c p Siu 3/�! `
Modei Iv�ber ��d Located At ��7� 7'����
s«�a�N�ba �r�'776f 9
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V�CUUM BREAI��t
Double Check Valve Assembly
lst Check 2nd Checi: 'ef Valve Air Inlet Check Valve
Inical Test DC-Closed Closed Ti;ht Opcaed at Opened at csid
,, � Ti�t ),� Leal:ed � o �sid _osid
�'7-v�'�� RP-__psid 1� �
Leal:ed ❑ Did not Opea o L,eal►ed �
RePair�
and .
Mat�rials
Usod
Test After DC-Closed Closed Tight o Opened at ppeaed at _�sid
Repair Tight a �sid _osid
RP sid
The above is certified to be true.
Firm Name n i v�r�1�0'C Catifiod Testa �, f
Firm Address 1'�� ��` ��7�j�•I�-,�`Y' 7� Cert. Testc No. � ?�`'� Date �`��/
(�suge # _ ��f 3:�5 6`S
Date last accuracy tested y -o?,?-��
White- Customer's Copy Yellow - City Copy Pink -Tester's Copy