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2014_0715 C�IECK ONE: IRItIGATION � DOMESTIC FIftELINE BACI�LOW PREVENTION ASSEMBLY TEST AND MAIIV'I'ENANCE REPORT rrp�OF Pws: CITY OF COPPELL PWS I.D. # � � � � � � � .� LOCATION OF SERVICE: _� c�` ` ��"A�� ` �r�c. y '..' r.z�_��r � The bacl�low preveation assembly decailod below has baa tesud and ma�nL�ed as required by TNRCC rcguladons aad is cerdfied to be operating withia acceptablc paramcta�s. TYPE OF ASSEMHLY e Reduced Pressvre Priaciple � Pressure Vacu�Breaker ��'' Double Chcck Valvc o Amiosphere Vacuum Breal:er _ ;� , , Maaufact�er a'_��'�'�> Siu �-��V Modei Number 'i.' `:--- �' Located At �1 v��'' � �!! r; ,-�'� Serial Nimmber '�/f`��'� � �/� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Check Valve Assembly lst Check 2nd Chec�: Re1ie{Valve Air Inlet Check Valve 0 Ininal Test DGClosed .�•� Closed Ti,Qht'�` Opened at Opened at osid Tisht Leal:ed o vsid �osid R.P-_psid �;� ❑ Did aot Opea o Leal:ed � RePairs aad Mataials Usod Test After DC-Closed Closed Tight o Opened at Opm�d at �sid Repair Tight � �sid osid RP sid The above is certified to be true. . .. -�� r r � � �.� _,,�� ' �c.J-,! � , � � Firm Nam� t/ .s' c'�' CeraS�od Tssta �- . y r�� r Firm Address-�� `'� :�r� �' `>� Cert Tester No.�''Y:'�" `_ �1 C� Date �= �; � Gauge # C''�"�/ �';� ' llate last accuracy tested ��"��- /�r' White- Customer's Copy Yellow -City Copy Pink-Tester's Copy �