2014_1105 C�iECK ONE:
IRRIGATION ✓ DOMESTIC FIRELINE
BACKFI.OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PwS: CITY OF COPPELL
PWS I.D.#
LOCAT'ION OF SERVICE: 1 Z� (��u� �r`r.,n f�a. �.��Pc cc. , )x 7561q
The bacl�low prevmtion asscmbly detailed below has bcea tested aad ma�nta�n� � nq� bv TNRCC
regulations aad is certified to be operating withia acceptable paramcters.
TYPE OF ASSEMBLY
C Reduced Pressure Principle e Pressurc Vacu�Breaker
3� Double Check Valve ❑ Atmosphere Vacuum Breaker
Maaufacnaer �E�Cc) Siu 2 .,
Modei Nimmber �S�� Located At �� (�e-�.�e►2: .�1-r t��i G T t 2
Scrial Ni�ber I-1 �2 7 �I(v
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Double Checic Valve Assembly
lst Check 2nd Checl: Relief Valve Air Inlet Check Valve
Inival Test DGClosed Closed Ti,,P.ht Opened at Opened at nsid
Tighi Z,� Leal:ed ❑ __,Dsid __osid
RP-_psid 2 �v'
�;� ❑ Did not Opea o Leal:e� O
�P�
aad
Mataials
Usod
Test Aft�er DC-Closed Closod Tight o Opeaed at Opened at __�sid
Repair Tight o nsid osid
RP sid
The above is catified to be we. �,�
Firm Name /�+�LI ��n�� �5a-r,�r��_ Cerrifiod Testa �+����T•TOµE�. G�a fi Forr-�
Firm Address I'�1� 1���+y ��.#N a 3 Cat Tester No. �Pc9�13 3 o fv Date Z-Z d �is
cArzn.���ro�, �x 7s�7
Gauge # Q 8�y�ssi �
llate last accuracy tested 1/-S-1�/
White - Customer's Copy Yellow - City Copy Pink-Tester's Copy