2014-0317 (9) C�IECK ONE:
IRRIGATION_�_ DOMESTIC FIRELINE
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D.#
LOCATTON OF SERVICE: � �� r� '''`��'�� �
'Ibe bacl,�tlow preveation assembly detailed below has beea tested aad main a;r� � nq� bv TNRCC
regulanons and is certified to bc operating withia acceptablc parameters.
TYPE OF ASSEMBLY
C Reduced Pressvre Principle C Pressure Vacu�Breaker
� Double Check Valve o Atmosphere Vacuum Breaker
��
Manufact�aer �✓� �"�s Siu �
Modei Nimmber ������� Located At ��fr�
s«;�N�ba �/ �� g�
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Double Check v alv�Assembly
lst Check 2nd Checi: ReIief Valve Air Inlet Check Valve
Initial Test DGClosed Closed Ti,Qht � Opeaed at Opened at osid
Tight �'� � Leal:ed �_ ❑ nsid _nsid
RP-__psid �`a
Leal;ed o Did not Opea o Lealced �
�P�
and
Mat�erials
Usod
Test ARet DC-Closed Closed Tight o ppeaed at Opeaed at __nsid
Repair Tight ❑ Dsid osid
RP sid
The above is cadfied to be true.
Firm Name �-�:��� �"/'�r_ Certifiod Testa ��d�'— ���/�9i¢�-
Firm Address���,,�'�X ��7 f/1�r�'� T,r Cert.Testc No. ���0�'`"�7r.,�'- Date /��= ��
(�auge # �.�''G/��%/I>�
Date last accuracy tested 7-�7��� �
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy