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2014_0715 . . . . . I . .. .... ,„�, e . __ _.,,.�..:,. _.. , ,,.ar'm"`,c,.w*+. 4 " ..,�� .._ . .. C�IECK ONE: , _ IR1tIGATION �'` DOMESTIC FIRELINE BACI�LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPOR? NAIv�OF PWS: CITY OF COPPELL , PWS I.D. # �` . LOCATION OF SERVICE: � l ;n�-. �1 ,�,,t .`v� i��y� ��' The bacl�-flow prevmtion asscmbly detailed below has beea tested aad maintained � require� by TNRCC re_euladons and is cerdfied to be operating withia acceptable parameters. TYPE OF ASSEMBLY C � Reduced Pressure Principle e Pressure Vacu�Breaker ;��'`��` Double Chxk Valve o Atmosphere Vacuum Breaker � � ; . Maaufactiaer � �`'u ; ; 't�.t � � � Siu ==>%�'�t" �._ ., , . Modei Nt�ber '.� '� �.-`� Located At ' " ' ' ° � . 4 i $CfI31 Tll�ibG! l�i��l� 1� -�1 5 , , " '{% REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Check v alve Assembly _ _ _ _ ��::- �._ -+�� . � lst Check l � 2nd Checl: 'ef�alve Air�nlet Check Va1ve Inival Test DGClosed C Ti;ht Openai at ! Opened at osid j Tight eal:ed sid � psid , 1 � '.�" RP- �• sid � �� . � �� `' 1,�;� � `--� ' Did not Open o L,eal:ed � �P� � f., � \, j� � f M3LGl131S 'i `�i .. 'i\��_: ti ,, ,�-�i ITSCd Test ARet DC-Closcd Closed Tight o Opeaed at Opea�at _�sid Repair Tight ❑ �sid _osid R.P sid The above is certified to be we , `a ,�.�, '-�'`�� 1`�''�-��` �u ��'�r � Testa `�� "`�"°a`�,��, ' �, �:� .z�.� � Fiim Name ._ ; ' � � ,, � _ .�,. _ �� ,� 3.; �., ,f 4 ,/ ti.j�rl�< � ..._)��i.._-,.1"i ^�j , _ � � ` 1..�,... Firm Address ��-,E --� �� .s 1 La Cert. 'Teste Na �� _,�° _�``�� Date �' , -i + � j . , .-��' .. II , ''" !1 Vglig@ � �_1 �+' `'} j.�'�"� � i 1 G=, i r>, llate last accuracy tested t � , ' -�� White - Customer's Copy Yellow - City Copy Pink-Tester's Copy