2014-0908 (3) �;
C�IECK ONE:
IR.RIGATION DOMESTIC FIRELINE
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D.# �t�.��eG�.s
LOCATION OF SERVICE: //�� /V�• ��`�'�.� � /�-�'C.-
The bacl�low prevtntion assembly detailod below has beea tested aad maintained as required by TNRCC
re�uladons aad is certified to be operating within acceptable paramcters.
TYPE OF ASSEMBLY
�C Reduced Pressvre Principle � Pressure Vacutmm Brealcer
Double Check Valve o Amnosphere Vacuum Breaker
Maaufacnaer �T��'/,�.��d S Siu /I �Z
Modei Ntimmber ���J �C L— Located At l?�t..Yt 7c,i" Ci[.r�. j���.����" ���� .
Serial Nimmber ,�`7�",.�[a�1
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Double Check Valve Assembly
lst C3eck 2nd Checl: Rdief Valve Air Inlet Check Valve
Inival Test DGClosed ��'a osed Tight Opened at Opeaed at nsid
Ti�t � Leal:ed ❑ �sid _nsid
RP-_psid
�� ❑ "'s ` n Did aot Opea o Leal:ed o
�P�
aad
Mataials
Used
Test After DC-Closed Closed Tight a Opeaed at Opeaed at _�sid
Repair Tight ❑ �sid osid
R.P sid
The above is catified to be true.
,
Firm Name � �� �� 'a� ' ,t�j7�ertifiod Testa : L�:� ' ,��'�
Firm A����. �V ll5v �'l,������ Cert. Tester Na Date� —�7--I
7c�o��s T�
(�auge # /")G%A�//Cs��,
llate last accuracy tested f'Z-/Z 7`�
White - Customer's Copy Yellow - City Copy Pink -Tester's Copy