2015_1020 C�IBCK ONE:
IRRIGATION�_ DOMESTIC FIRELINE
BACI�'LOW PREVENTION ASSEIVIBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATTON OF SERVICE: ���1 (�01?���r �` �(,��}��?_
The baci�low preveation asscmbly detailed below has beea tested aad ma�ntain� � nq� bv TNRCC
reguladons aad is cerdfied to be operating within acceptable paramcters.
TYPE OF ASSEMBLY
C/ Reduced Pressure Principle � Pressure Vacuimm Brealcer
�' Double Check Valve o Atmosphere Vacuum Breaker
Maaufactiaer
�.,/,�;�S s� 3fY
Model Ivumber 3S � Located At �
Serial Nimmber �7'1 ��� 7� �d��� 071 Y'1��i,f SJ� ��
:���15�7��
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Double Check v alve Assembly
lst C3eck 2nd Checl: Relief Valve Air Inlet Check Valve
Inidal Test DGClosed Z-S Closed Tight Opened at Opened at nsid
Tight d Leal:ed o �sid _osid
RP-_,psid (o
-��j,� Leal;ed o 2" Did not Opea O Leal:ed o
�P�
aad
Materials
Usod
Test AR,er DC•Closed Closed Tight o ppened at Opeaed at �sid
Repair Tight 0 _nsid _,osid
RP sid
The above is cerdfied to be true.
Firm Name Ol Aecurs�y Backflow Catifiod Tester �17I,�1�/? �,�A�1 7'��1��-i��'1 �
�#99ti'Bartbn Circle �
Firm Addre,4s Cat Testc No: U� Date 4'Z�T- �
�
(�auge � _U ��to��
•--
llate last accuracy tested_��'/S
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy