2015-0317 C�iECK ONE:
IRRIGATION DOMESTIC FIRELINE X
BACICFT.OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: � �� r� e e ��,t �"
'Ibe bac1.-flow preveation asscmbly decailed below has beea tested aad n,aint�� � nq�� by T'NRCC
reguladons and is cerdfied to be operating within acceptable paramtters.
TYPE OF ASSEMBLY
❑ Reduced Pressure Priaciple C Pressure Vacuimm Breake,r
� Double Check Valve o Amuosphere Vacuum Breaker
<<
Maaufactsaer � � ��s Siu �
m [-. �'
Model Iv�ber � � y Located At � . t ��
Scrial Nimmber l��'i // 7 Q ���
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Double Check v alve Assembly
lst Check �nd Checl: Relief Valve Air Inlet Check Valve
Inidal Test DGClosed Closed Ti�ht �. Opeaed at Opened at nsid
Tight �°� l� Leal:ed ��.,,� o nsid _osid
RP-_psid
I,�;� o Did not Opea o Leaked �
�� �e/��i�l �c! � a /��
Mataials
Usod
Test ARv DC-Closed Closed Tight o Opened at Openod at �sid
Repair Tight � osid _osid
RP sid
The above is certifiod to be true.
Firm Name l���r o r�- l"i�� Certifiod Testa �' �G c L�! �l���� -�
Firm Address 1�.0./�o Y 7�'f? (,Uy�x A� Cert Teste No. %���o a�r�e� �� �-� �/.�
Ga� � �G r��r� 7��
Date last accuracy tested � �� �� � �
White - Customer's Copy Yellow - City Copy Pink-Tester's Copy