2013-1212 C�iBCK ONE:
IRRIGATION 1/ DOMESTIC FIRELINE
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAIv�OF PWS: CITY OF COPPELL
PWS I.D. # /�V�v�-�S
LOCATION OF SERVICE: �/z- N�• /�n�- '7- � �L•
The bacl�low prevmtion assembly detailed below has baa tesud aad ma�nta�r� � nq� bv TNRCC
re_�ladons and is certified to be operating within acceptable parameters.
TYPE OF ASSEMBLY
e �Reduced Pressure Priaciple e Pressure Vacuimm Breaker
�� Double Chxk Valve ❑ Atmospherc Vacuum Breal:er
Maaufacaaer � 'b'�L` Siu � i�-
Model Number ��f G���}L�T_ Located At �/Z�" °��°1- /���P-�n1��►�� .
Scrial N�ber G '� ,�,��
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACULJM BREAI�R
Double Check v alve Assembly
lst Check 2nd Checi: Relief Valve Air Inlet Check Valve
Ininal Test DGClosed�• % Closed Tight Opeaed at Opened at osid
Tig�t Leal:ed a �sid _nsid
RP-_�sid �� �
� . �;� o Did not Opea o L,eai:ed �
�P�
and
Mataials
Used
Test After DC-Closed Closed Tight � Opeaed at Opeaed at _._nsid
Repair Tight ❑ �sid �Dsid
R.P sid
The above is certified to be true.
Firm Naare Y� y y�. Catifiod TGster /�•�tt��+��2r.r��
r
Firm Addre�+�t��r y��Z>` �i�,._ Tx Cert. Tester No. ' 89 Date l- 7-�
F�,c��
ca� � l�0 e//%�i�
Date last accuracy tested /�/z�,j
White - Customer's Copy Yellow - City Copy � Pink-Tester's Copy