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2013-1230 C�IBCK ONE: ., IRRIGATION �OMESTIC� FIRELINE u �_. k: -- � t BACI�Z,OW PREVENTION ASSEMBLY TEST AND MAIIVTENANCE REPORT � �, ' : �' NAME OF PwS: CITY OF COPPELL- ? �� : � + PWS I.D. # � LOCATTON OF SERVICE: 7�� o r� �. � . ' 'Ibe bacl�low prevmtion assembly detailed below has beea tested and maintained as required by TNRCC , re�sulations aad is certified to be operating within acceptable paramtters. TYPE OF ASSEMBLY e .: ,.Reduced Pressur�Pri:}ciple y � ; C < PressWe Vacu�B�eaker . . �ouble Check VaIve 4 � R o � t+�mio'�pherrt'Vacti�m Srealctt � ' � . " � � , Maaufact�er (/��{.� Siu l��—�r Modei Ivumber d� 7 Located At �d �l 1.�.�� f�`P� Sezial N�ber �%�'�� . REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R � Double�heck�%alve Assembly lst Check 3nd Checl: Relief Valve . Air Inlet Checic Valve Inival Test DGClosed Closed Ti,pht � Opeaed at Opened at �nsid Tight �,� � Leal:ed ❑ �sid _nsid RP-__psid �r��,; Leal:ed o �' � Did aot Opea o Lwl:ed � RePairs aad Materials � � � , . Usod � . , , � . . ; _ - - , b . ,.: . • . . ..�„ � . , ,. Test After DC-Closed Closcd Tight o Opeaod at Opea�at �sid Repair Tight o �sid __osid RP sid T'he above is certified to be true. Firm Name ' �. �� r- c PS�t�atified Testa I �` o�e ` i � Firm Addres.s , � �� ( � Cat Testc No. ,G'r��l f��-Z� Date �' 23 - � � ��r '�� j 1,�7��D� s� vauge # �� , -� Date last accuracy tested ��Z 3 U White- Customer's Copy Yellow - City Copy Pink-Tester's Copy