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2015-0109 C�IECK ONE: IRItIGATION DOMESTIC '� FIRELINB BACT4'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPOR? NAI�OF PWS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE: _�� `nZ.�,Pc��'� P kW�`I The bacl�low prevmtion assembly decailed below has beea tested maintain� � nq� �, '�CC reguladons and is certified to be operating withia accrptable paramcters.��/�5 ,�� TYPE OF ASSEMBLY � Reduced Pressvre Principle � Pressurc Vacui�Brealcer Double Check Valve o Amiosphere Vacuum Breaker �� i Manufact�aer w A?'rS Siu Model Number �U M ' Located At h�i w�.c��3 ��_ ��5T�t,+-i.; Scriai Ni�ber L�'`k��w — �S 'T�'�'i G�R2:.�aFA� Double Check Valve Assembly lst Check 2nd CLecl: B.r.�v..�.•- Inidal Test DGClosed Closed Ti;ht o Opeaed at Opened at nsid Tight ❑ Leal:ed ❑ nsid �si RP-_psid �;� � Did not ea o L,eal:e� o Repairs � I�le.� �l-a< <�sr S��e � ��(z5 � � �`�� 7'" �/� Mataials �/��k% ��' �a.�-= Usod c�tec k ��ss�51 c.�e�.�C�s s . Test ARer DC-Closed losed Tight at Opmad at _nsid Repair Tighi $. � r sid �osid � sid ' T'he above is certifiod w be tzue. Firm Name��S Catifiod Testa ,►��IC" "--^ Firm Addrcss I 3�S^a �>,�1a�N�� -fl+- Cett Tester No�f'DOU��6�" D� - �`� ' 2�� F�LAS 'T—� 73'Z3� Gauge # /2�7l`;�J llate last accuracy tested �' � ' 2°�S White- Customer's Copy Yellow - City Copy Pink-Tester's Copy