2014_1218 �� Lc�ar l��-���-
C�IECK ONE: __
IRRIGATION DOMESTIC FIRELINB
BACI�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
N�ME OF Pws: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: __ $�� � �-d D R��� ��-
The bacl�low prevmtion assembly detailod below has beea tested and maiatained as required bv TNRCC
regulauons aad is certified to be operating withia acceptable paramcters.
TYPE OF ASSEMBLY
e Reduced Pressure Principle C Pressurc Vacuimm Breaker
� Double Chxk Valve o Amiosphere Vacuum Breaker
� �i
Maaufact�er � � � Siu
Model Ivt�ber GD� � .Z � � Located At
Scrial N�ber ��� 7,3.3
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER
Double Check Valve Assembly
lst C3eck 2ad Checl: Relief Valve Air Inlet Check Valve
Ininal Test DGClosed Closed Tight �' Opeaed at Opened at csid
�Z f Ti�t Z, '� � Leal:ed ❑ _osid __nsid
I($/r ` RP-_psid
� `I I,eal;ed o Z�Z Did not Open � Leaked O
��
aad
Mataials
Used
Test After DC-Closed Closed Tight o ppeae�at Opeaed at _�sid
Repair Tighi o nsid _�sid
R.P sid
The above is certified to be we.
Firm Name Catified Tester �e r r y �l.�ex�1's
Firm Address Cat Teste No.�S P L�d 12-? D� /2—/8'�'f
�a�e � DD�� Y7.�
Date last accuracy tested a� �-��-,/�
White - Customer's Copy Yellow - City Copy Pink-Tester's Copy