2013_0830 C�IECK �NE:
LRRIGATION � DOMESTIC FIRELINE
BACI�ZOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LocAnoN oF s�vicE: �'� � ,� �/ f �1 C�� � �'��_I �r I � ��SC�� �
The bacl�low prevmtion asscmbly detailed below has bxa tested and maintained as required bv TNRCC
rc�ulanons aad is certified to bc operating within acceptablc paramcters.
TYPE OF ASSEMBLY
❑ Rcduced Pressurc Principlc C Pressvre Vacui�Breaker
9� Double Check Valve o Am�osphere Vacuum Breaker
�,� 1� �,�� , �
Manufact�ez �V' , '��� Siu
Modei Ivumber y� Locatcd At l� �'.�(�I I/��0 I � ����
sa;al N�ber
P�����1 ��' �er
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACULJM BREAI�R
Double Check v alv�Assembly
lst C3eck 2nd C3ecl: Relief Valvt Air Inl�t Check Valve
Inival Test DGCloscd Closed Ti;ht Opened at Opened at osid
Tidii Lcal:cd ❑ Dsid osid
� � IL� RP-�sid
I �;� ❑ �� � Did aot Opea o Leal►ed �
�P�
� N ��� �� I V�
Mataials
Used
Test ARer DC-Closed Closed Tight o Opeacd at Opmod at _nsid
Repair Tight ❑ �sid nsid
RP sid
The above is cerdfied to be true.
Firm Name. �'�' G I �U��1�'Certified Tcsta ��� A rS
� �� v'V. P � t��1 s�' . Sfi�' ��3 �51 n� I
Firm Address � � � Cert. Testc No. �� ��
���
Gauge # �(,�Q����
llate last accuracy tested ��
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy