2014_0715 (3) - '"T� . , � _,..- ,. - , . , �. � , ., � .- , . , - . -,-�, ,. . , . - , .� . , , . . ... , ;�. � �a�. --- . . ,- , . �
C�IECK ONE:
IRRIGATION DOMESTIC FIRELINB�
BACI�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAN�OF PWS: CITY OF COPPELL
PWS I.D.# " .
LOCATTON OF SERVICE: � �. � �P V�v1
The bacl�low preveation assembly detailed below has beea tested and ma�*+t�ed as requirod by TNRCC
reguladons and is certified to bc operating withia acceptable parameters.
TYPE OF ASSEMBLY
e Reduced Pressure Pcinciplo e Pressure Vacuimm Breaker
�yj/ Double Check Valvc o Atmosphae Vacuum Bnal:er
Maaufacuaer �� P O r O Siu -?��/ ' ,
Model lvumber 9�� S � Located At % ro� � c�Q r _
Serial Nimmber ���� �.��$ �
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUIJM BREAI�R
Double C3eck V alve Assembly '
lst C3eck 2nd Check Relief Valve Air Inlet Check Valve
Inidal Test DGClosed /• `j Closed Tigh�' Opened at Opened at osid
Tight Leal:ed o nsid ___esid
RP-,_,psid
I,�;� ❑ Did not Opea o Leal:ed O
. RePairs
aad
Mataials
Usod
Test After DC-Closed Closed Tigl�t o Opened at Opmod at nsid
Repair Tight o flsid osid
RP sid
The above is certified to be Crue.
Firm Name
�/v P Y 5 I d-� Certificd Tester�`� �b S C�'��
Firm Address D d�� ll` � �7i►' Cert.Tester No�r'o o/3��o Dam — /��/ !
ca� # �� 13 / ��G .
Date last accuracy tested - /.� -
White-Customer's Copy Yellow-City Copy Pink-Tester's Copy