2014-0606 C�iECK ONE:
IRRIGATION�_ DOMESTIC FIftELINE
BACI�ZOW PREVENTION ASSEMBLY TEST AND MAIIV'I'ENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATIOIv'OF SERVICE: ,���'���1��YI�/ ��� � ��'� I� �/� I=.A�
The bacictlow preveation asscmbly derailed below has beea tesied aad mainta�n� � nq� bv TNRCC
regulazions and is cerdfied to be operating within acceptable paramtters.
TYPE OF ASSEMBLY
❑ Reduced Pressurc Pr'inciplc � Pressur�Vacuimm Breaker
� Double Check VaIve � Atmosphere Vacuum Breal:er
Maaufaci�er �'L�� � Size �
Model Ivumber ��� Locatod At /`"��"�
s�;�N�ba �f- p ��'-1'�
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Double Check Valve Assembly
lst Check 2nd Checl: Relief Valv� :,ir Inlet Check Valve
Inival Test DGCloscd Closed Ti�t Opcaed at Opened at vsid
Tisht Leal:ed ❑ �sid osid
RP-�psid 2 ,�
I,�;� p Did not Opea o Leal:ed O
Repairs
and
Materials
Used
Test Aft�er DC-Closed Closed Tight o Opened at Opeaod at _nsid
Repair Tight ❑ osid osid
RP sid
The above is cerdfied to be true.
Firm Name Ol Aecurs Backflow Certified Testa �
arton Circte � �^ �,�/
Firm Address Frisco,TX 75d�5 Cert Tester No. Date "�
972-699-71�
t3auge #
llate last accuracy tested r r
White - Customer's Copy Yellow - City Copy Pink -Tester's Copy