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2015_0320 (3) C�IECK ONE: IRBIGATION DOMESTIC FIRELINB � BACI�LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT rr,�OF PwS: CITY OF COPPELL PWS I.D.# LOCATION OF SERVICE: 1223 �res�sid�. �D/�� Thc bacl�low prevcation assembly decailed below has beea tested aad maintainod as ra�u�+ed bv TNRCC regnlations and is certified to be operating rovithin acceptabic para�sers. TYPE OF ASSEMBLY c Reduced Prrssure Principle e Pressure V�Brealceer �' Double Check Valvc o Amaosphete Vacw�m Breaker Maaufacturcr �,l�l���S Siu 3�� �' - Model Iv�bcr �(�7/�l 3 Located At �!�-�10�'Il,c�-� ,���l�G'rSS � s�N� 2 l0 3 Z� REDUCED PRE.SSURE PRINCIPLE ASSEMBLY PRESSURE V 4CUUM BREAI�R � Double Check V alvt Assemblr � lst Check 2nd Cbeci: Rdief Vatve Air Ialet Checic Vatve Initial Test DC-Closed Z•Z Closed?i�ht ,k� Qpeaed at Opeaeci at ��nsid Ti�t � L,�al:cd o �sid osid Rp•_psid 2'� �� ❑ Did�Opm ❑ Leal;ed � �P� aad Mata�ials Usod Tesc ABer DC-Closed closod ri�t o Opeaed ac Opemed ac _,,,psid Repair Tight ❑ �id _._,osid RP 'd Tbe sbove is ceitifiod to be�ve. Fir�m Name��c n v� ��'p �S Catified Testa 1/Gx��vi ffUS 7o ti! F'�cm Addc+ess,/"�1,��X '97 Cat Testc No. Q�DO ID(oS I Date 3 '� l5 1��kCt�91f C�iIC� Tx Gauge # d�@//Dl) 7`� Date lest accuracy tested �