2014-0620 C�IECK ONE:
IRRIGATION DOMESTIC FIRELINE �
BACT�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATTON OF SERVICE: L' �c�v�. L'�--�Pyr'�•c y � 3 J S ����• �'�E,., 1`�, �
/
The bacl�low prevmtion assembly detailed below has beea tested aad ma�n ain� � nq� �, 'I'NRCC
re_�ons and is cerdfied to be operating within acceptablc paramcters.
TYPE OF ASSEMBLY
C Reduced Pressure Principle � Pressure Vacui�Breaker
� Double Check Valve o Atmosphere Vacuum Breaker
Maaufactsaer L,) � � �c� � s Siu �S
Model Nimmber��C�� S� l��t Located At r/c�µl � � �J c u ,r�n� �?�-��',� ,�
Serial Ni�ber j��� 3
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Doubie Check v alve Assembly
lst Check �nd Cbecl: Relief Valve Air Inlet Check Valve
Ininal Test DGClosed 3 . � Closed Ti,,Q.ht Opeaed at Opened at �id
Ti�t Leal:ed ❑ �sid ,_osid
RP-_psid
Leal;ed ❑ ��' � Did not Opea o Leal►ed J
�P�
and
Materials
Used
Test After DC-Closed Closed Tight o ppened at ppeaed at _T sid
Repair TighL ❑ _csid _,osid
RP sid
T'he above is cectified to be true.
Firm Name}�'�r� V�r G r u� )����� ����,, Catified Testa ���-�� �` t c ��•��•.e
Firm f ���13 �"� Cat Taste No. ��r� �Z��co Date � 'Z`r �� y
�rr`.�., h v�1 ►� T'1�. ? �`I S b
Gauge # �� f 1 t,�i �'
llate last accuracy tested U -- �-"�`�'�
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy