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2014_0521 . . �. ; � , ., x�:5�! C�IECK �NE: ` . , �I IRItIGATION DOMESTIC FIRELINE � BACI4'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT �� NAN�OF PWS: CITY OF COPPELL PWS I.D. # , LOCATION OF SERVICE: �5.� C i�.� N�: C,��r�� £ The bacL-flow przveation asscmbly detailed below has beea tested aad n'+a�t�ed as required by TNRCC regulanons and is cerdfie�to be operating withia accrptable paramctas. TYPE OF ASSEMBLY e Reduced Pressvre Principle ❑ Pressure Vacut�Breaker : �. •- - _- -, _. _ ,.',� _ ,-I2�u�lc Cb��k ya�ve � _ .� _x o ._.__ Amiosphere Vacuum Breal:er. ____ _ ' � - _ _ _ _ � Maaufact�uer �-1 rn�S Siu ��\ Modei Iv immber �C,C;Y�'� Located At 1 f X"�'-i C f��, .r� .\ Serial N�ber ��f�� _ REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Check Valve Assembly lst Check 2ad Checl: Relief Valve Air Inl�t Check Valve Inical Test DC-Closed Closed Tight t+� Opened at Opened at �sid � Tight e' Leal:ed o nsid __osid �� R.P- t,`� psid � . I,eal;ed a � Did not Opea o L,ealce� O Repairs _ y i i , , , � , �.; Mataials , , � � _ '.�� Usod r ; Test Aftv DC-Closed � Closed Tight o Opeaed at ppeaed at �sid � Repair Tight o _flsid nsid � - RP sid The above is ceitified to be true. �,� ��,.. a�� ` i Firm Name�ti�w�.,.,._ c �c J �t�� o�, Ce�,tified T , Firm Addc�ess Y �i I X Cert. Taster No. �`a��1�'��3 Date - t�` t`� �. c�_.�`� C �,r ' _"' ' � �-��_�__ �,�--:,��- - � ..� ,, . c8�e � n�►i�z��-� � Date ]ast accuracy tested �- Z�- �� White - Customer's Copy Yellow - City Copy Pink-Tester's Copy _ _ _ _ _ ._ �