2014-0620 (5) C�IECK ONE:
IRRIGATION � DOMESTIC FIRELINB
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINI'ENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: � 1'`�' �=��� ���"� ��-e 1�,.
'Ibe bacl�low preveatioa assembly detailed below has bxn tested aad maintained as required by TNRCC
reguladons aad is cerdfied to be operatiag withia acceptable paramcters.
TYPE OF ASSEMBLY
e Reduced Pressure Principle C Pressure Vacuimm Breake,r
� Double Chxk VaIve o Amnosphere Vacuum Bnaker
Maaufact�er �'"c �.�� v Siu f ��Z...
Model Number � `� Located At f�-�e �'�� a+ n�+ �'���•,`� w •S �
S!� P S ��Y��e L
Serial Nimmber �� �- ��1 �
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER
Double Check v alve Assembly
lst Check 2nd Checi: Relief Valve Air Inlet Check Vaive
Inival Test DC-Closed f Closed Ti;ht Opened at Opened at _nsid
Ti�t Z-�-' o Leal:ed o osid _osid
RP-_,psid �-S
L,eaked ❑ Did not Opea o L,eal:ed ❑
�P�
and
Materials
Usod
Test Aft,er DC-Closed Closed Tight o ppeaed at Opeaed at _�sid
Repair Tight o �sid _osid
RP sid
The above is cerafied to be true.
p , ,- � � ,�
Firm Name I�..�i �'y�,'.¢ � � .�.� � �'�.°�����--°`Certifiod Testa ',�` 4 ��,k, ����'�; �t.;,:��,� � �� '.�.�.
> �,�� � �� F ., .- .z ► -i
Firm Addreu 3 ���! '� '�� � `� '` '� Cert. Te.ster No �''�'_1�,��'� ��Date � � �
� , , -•� _
, , ,:
�,.��. � . ! ;� � f� _� %� .�' �_
Gauge # E' 1 ; €��, '�1 ;'� � �
llate Isst accuracy tested �€ � `' �$�
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy