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2014-1111 (2) C�IECK ONE: IRItIGATION DOMESTIC FIRELINE V "'; BAC�'LOW PREVENTION ASS LY TEST AND MAINTENANCE REPORT ; ',�� � NA1ME OF FWS: CITY OF COPPELL �'J�O l i�� �1 S�T'� � OU . f��i C���11�.,�,� � ,�t .. : ,s�,�";,,,`�t= :: PWS I,D.# _ .;� � ` � ��°�� P�2�vv ,� .� �x. LOCATION OF SERVICE: �� ���� r 1�-t.-�' ��� A � � The bacl�low preveation asscmbly detailed below has beea tested aad maintained as required by TNRCC regulaaons aad is certified to bc operating withia acctptable parameters. TYPE OF ASSEMBLY � Reduced Pressure Principle C Pressure Vacu�Brealcer �i Double Chcck Valve o Atmosphere Vacuum Breaker ._ ._., . ..,. �__ . ��.. __ . . .; ; _ � � � , � - �, _ � �. -�-���; ., _.._ ._ � S;� . . „�, �� _ _� ,__ . . . _ Ivtaaufacttaer . Model Iv�ber �.a`�`� �j�'�?j Locaud At � �-I.:e ���1'� t�,.�'J1�1�1 Scrial N�mmber �(��5Ea -'� _REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER ,�y .A Double Check Valve Asseanbly k` _._..-,-,�- ; lst Check 2nd'Checl: Relief Valve Air Inlet Check Valve Inival Test DC-Closed Closai Ti�ht �1 Opeaed at Opened ai osid Ti �! Lcal:ed O _�sid �osid ` � RP�,psid � � �7 L,eaked ❑ Did not Open � Leal:e� o ' RePairs , and Mataials Usod - _._, - Ies�AfTr��. ,Clos�d _, _:_ . --Closed Iight.._ Op�aed at . -.__ ' �. , Q�ad.�t., _ _-_- . ,,-,��;_ns�d ._,, _. . Repair Tighi o flsid nsid " RP sid The above is catified to be true. Firm Name t �' ���; `ri ���_i'� Catifiod Teste �� l�� � � � �� t� �� Firm Address ��l,tk'S . I=hS Cert Tester No. Date � ,, �8�e � ��Q� ��Q� � �� - .,� ---•..�,�,; f llate last accuracy tested �i �� 1'� s White- Customer's Copy Yellow - City Copy Pink-Tester's Copy