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2014_0529 :>_ <� �_,... , ,_, k, �,� u _ _ . , m . C�iECK ONE: IRRIGATION � DOMESTIC FIRELINE BACI�Z.OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPOR? NAIv�OF PWS: CITY OF COPPELL PWS I.D. # ,, � ,� f LOCATTON OF SERVICE: �� l/� The bacl�low prevmtion asscmbly detailed below has beea testcd and maintained as required bv TNRCC rc_gulations aad is cerrified to be operating within acceptable parameters. TYPE OF ASSEMBLY � Reduced Pressure Principlc � Pressure Vacuimm Breaktr ^ Doublc Chcck Valve � Atmosphere Vacuum Breal:er � �� Manufact�er f� ��:�, Gc� _ Siu � Model Number �� Located At ' /'�'/1� ` �'" Serial N�ber �-i� `�� i L '-� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Check Y�lve Assembly lst Checic 2nd C3ec1: Relief Valve Air;Inlet Check Valve Inival Test DGClosed Closed TiQ t'� Opeaed at Opeaed at osid Ti�t �, Leal:ed o �sid osid RP-�psid �� `� � Did not Opea o Leal:ed � �P� and Mataials Used Test Aft,er DC-Closed Closed Tight o Opeaod at Opeaed at __�sid Repair Tight o �sid _osid R.P sid The above is cerdfied to be true. ,-. Fum Name �,��'i/��' i'�';�:t'i I7� Certified Testa � •��''�-�r //r/li� �� ,. _ Firm pd�G,c r � , (/. Cert.T�No.i� � ` ate �.1� , — �f Gauge # 'v` ��J � �' llate last accuracy tested_�- } "' / White- Customer's Copy Yellow - City Copy Pink-Tester's Copy