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2014-0317 (7)
C�IECK ONE: IRItIGATION DOMESTIC FIRELINE � BACKFI.OW PREVENTION ASSEMBLY TEST AND MAINI'ENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE: ��� ���� Pa�� The bacl�low preveatioa asscmbly detailed below has beea tested aad maiatained as requirvd by TNRCC reguladons aad is certified to be operating withia acceptable paramcters. TYPE OF ASSEMBLY e Reduced Pressure Principle ❑ Pressure Vacuimm Breaker �c Double Check VaIve ❑ Amnosphere Vacuum Bnal:er Maaufacturer ��� t�' Siu � ' Model Number �7� Located At ,f����- (��� i�.� Serial N�ber �����/7 z� 3�� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V�CUUM BREAI�R Double Check Valve Assembly lst Check 2nd Checl: Reiief Valve Air Inlet Check Va1ve Inival Test DC-Closed Closed Tight o Opeaed at Opened at csid Tight �• N R4� Leal:ed `� �sid _osid R.P-_psid I,�;� p Did aot Opea o L,eai:ed J �P� aad Materials Used � Test Aftet DC-Closed Closed Tight o Opeae�at Opea�at _._nsid ��1T 'r1�1L ❑ DSId DSld � Sld T�1C SbOVC 1S CCSnSOd LO bC tR1C. Firm Name f`rC�`i c�`� �//r� Certifiod Tester �`/�� G�/� ����s�s Firm Address �,�`.�C�� ��7 ���i�j«'�. T� Cert. Testa No. ��G��c 7�r �� �/—� ���y Gaug�e # ti�G�' y/T�� llate last accuracy tested �' ���7��� White- Customer's Copy Yellow - City Copy Pink-Tester's Copy