437 Carter C�IECK ONE:
IRRIGATION � DOMESTIC FIRELINE
BACKFLOW PREVENTION ASSEMBLY TES?AND MAINTENANCE REPORT'
N�ME OF Pws: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: f-7 �� � _��rfi� T r��K
The bacl�low prevmtion assembly detailed below has beea tested aad ma+*+ a;ned as required bv TNRCC
reguladons aad is cerdfied to be operating within acceptable parameters.
TYPE OF ASSEMBLY
e Reduced Pressure Principle C Pressure Vacu�Break�er
� Double Check Valve ❑ Atmosphere Vacuum Bnaker
Maaufactsaer 1 E tSC U Siu '��'�
Model Number `u'��� C� Located At �_ .. S �r�r �"?r<< � i-
Serial N�ber 1�C_ '���> X��-1 Z
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER
Doubie Check Valve Assembly
lst Check 2nd Checl: Relief Valve Air ldet Check Vaive
Inidal Test DC-Closed Closed Ti,Qht Opened at Opened at osid
Ti�t Leal:ed o nsid __nsid
R.P- I.9 nsid �. �
I,eal;ed o Did aot Opea o Leai:ed o
�P�
and
Mataials
Usod
Test ARer DC-Closed Closed Tight o Opeaed at Opeaed at __osid
Repair Tight 0 nsid osid
RP sid
The above is catified to be true.
Firm Name ��v E ��: i n� Catified Testa 1,.,�/�T�fc�rv�.1 ��aTT
Firm Address '� � ~ `� � Cert.Tester No. �t.'cc��3�t Date�20--(,�
� -�- ' I h "7l��C�
Gauge # :'3 7 �9 S''
llate last accuracy tested
White- Customer's Copy Yellow - City Copy Pink-TesteNs Copy