2014-0620 (4) C�IBCK QNE:
IRRIGATION DOMESTIC FIRELINB ✓
BACI4'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE:��'CG r e �,�.-,,„�.r � ,., �� � S /���}�.. '(�v , �
The baclflow preveation assembly detailed below has beea tested aad maintain� � nq� bv TNRCC
re¢ulauons and is certified to be operating withia accrptable paramctcs.
TYPE OF ASSEMBLY
C Reduced Pressvre Principle � Pressur�Vacui�Breaker
2� Double Chcck Valve ❑ Atmosphere Vacuum Breaker
Maaufact�aer 1�� � �� I�� w i Siu 3l`/ � �
Madei Number �j�u�- D Z Locaud At �I�u I�- Sc.,� ���.��,. �����•��7
Serial N�ber �x 7 C�t��-icr
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V�CUUM BREAI�R
Double Check Valve Assembly
lst Check 2nd Checl: Relief Valve Air Inlet Check Valve
Initial Test DGClosedZ-3 losed Tight Opened at Opeaed at _csid
Ti�t Leal:ed o nsid _osid
R.P-_psid
L,eal;ed o Z"� Did not Opea o Leal;ed o
�P�
and
Mataials
Used
Test After DC-Closed Closed Tight a ppeaed at ppea�at __nsid
Repair TighL o _�sid __osid
RP sid
The above is catified to be true.
Fiim Name t'�c.� V��c c� l�c. � �/�,.,,, Certifiod Testa ��� ��� 1�`I ��� �J•✓
Firm Address r�G 3�1 �Z � Cat Tester No. �Z'� Date�i -7 -r -� y
Gauge # �'j( 1 � G� � �
Date last accuracy tested G` �"`I "�
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy