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2015_0601 � C�iECK ONE: IRRIGATION � DOMESTIC FIftELINS BACI�'LOW PREVENTION ASSEMBLY TES?AND MAINTENANCE REPORT NAIv�OF PWS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE: ����� � �� e 5 �'S' f7� � � ( � r� ,�e � r' T X The bacicflow prevmtion asscmbly detailed below has beea testod and maintained as required by TNRCC regulations aad is cerdfied to be operating withia acceptable paramcters. TYPE OF ASSEMBLY �r Reduced Pressure Principle e Pressure Vacuum Breaker � Double Check VaIve � Amnosphere Vacuum Breaker K 5 Siu 2 Maaufacisaer �^� f ! , .^ Modei Number ��O� !. Located At �:cJ% 5 V�.� � �� ►^� �d c� �e IV � � t}� i/+� !=tit �<;. i���X Serial Nimmba �`-� ��7��_ REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACtJUM BREAI�R Double Check Valve Assembly lst Check 2nd Cbecl: Relief valve Air Inlet Check Valve Iniaal Test DGClosed Closed Ti�t '� Opened at Opeaed at osid Tight �!. Leal:ed o Dsid osid RP- ��sid t . , , �;� a � ' '' Did not Opea o Leal:ed � �P� aad Mataials . U� Test Aftet DC-Closed Closed Tight o Opeaed at Opeaed at �sid Repair Tighi � �sid �Dsid RP sid T'he above is catified to be tiue. �?�c,� Firm Name v�, � -r-{� ��-..� ��, ,.N + �h� Certificd Testa ��'`�33v�E�� i,�e,, �,, ,5 c.�,,� �,�,,�_ „�...a, Firm Address ' � � L�� �' }� ' `�,= J (� i) °;"� ``�C�at Tester No. � ��' �>'4 �����Date '� '_�S (3auge # `.��� u "> C� , Date ]ast accuracy tested y^ � � � � White - Customer's Copy Yellow - City Copy Pink-Tester's Copy