2015_0320 C�iECK ONE:
IR.RIGATION DOMESI'IC FIRELINE X
sACT�'r.ow PxEVElvrtox ASSEIV�LY TESr ANn MAiNi'ENANCE REPORT
NA1�OF PWS: CITY OF COPPELL
PWS I.D.#
LOCATION OF SERVICE: 12�3 C�r�S'-�t'��10 ��.
The baci�low preveation asscmbly detailod below has been testod aad maintained aS required bv TNRCC
regulations and is cerdfied to be operatiag within acccptable paramct�rs.
TYPE OF ASSEMBLY
e Reduced Pressure Priaciple e Pressurc Vacu�Breaker
�" Double Chcck Valve ❑ Amiosphere Vacwim Breaker
`� 3��',
Manufacnacr P.��'TS Siu
Model N�ber dD'7M3 Located At .��a iin��/,�- ,���S.S`
S«t�r+� �10 �DO
REDUCED PR£SSURE PRINCIPLE ASSEMBLY PRESSURE V�CUUM BREAKER
�C� Double Check vah►e As.sembly
J
lst Chetk 2nd CbecL- Rdief Yalve Air Inlet Check Valve
Iaidai Test DC-Closod 2•� Closed Tight � Opeaed at 4peaed at _�d
Ti�ht �' Leal:ed 0 Dsid nsid
R.P___Ps�a 2.o
�;� o Did not Opea o L�al:ed o
�P�
and
Matr�sials
Usod
Test Aftec DC-Closed Clesod Tight o Opene�at Opmed at _osid
Repair Tight ❑ osid ___,osid
RP sid
The above is cerdfied to be vue.
F'um Name �P-�-�nh �ir.� _P_n_� Certifiod Tesfa ll/,�e�s✓► �isTn�n
Firm Addc+�ss I'� �x �7�'�7 Cat Testc No.BPGb)P�(oS I Date--�;;��S
(,(�''zSCrc ytCtC.�CP ��c-
Gauge # ��t/D075
Date last accuracy tested ,,3