2014-0317 (11) C�iECK ONE:
IRRIGATION DOMESTIC FIRELINE �
BACKFLOW PREVENTION ASSEMBLY TES?AND MAINTENANCE REPORT'
NAIv�OF PWS: CITY OF COPPELL ,
PWS I.D. #
r ,
LOCATION OF SERVICE: ��� ���'� �'��'�
The bacl��low preveation asscmbly detailod below has beea tested aad maintained as required by TNRCC
regulations and is cerdfied to be operating within acceptablc parameters.
TYPE OF ASSEMBLY
C Reduced Pressure Priaciple C Pressvre Vacu�Breaker
'� Double Chcck Valve 0 Atmosphere Vacuum Breaker
f:r ��
Manufactsaer �'i`��S �" % Siu �
Model Number ����r Located At G��''���'`
Scrial Ivi�ber /�� ���j�
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Double Check Valve Assembly
���/ lst Check 2nd Checl: Relief Valve Air Inlet C'hecic Valve
Inival Test DC-Closed Closed Ti,,P.ht � Opeaed at Opeaed at nsid
Tight ❑ Leal:ed 0 nsid _nsid
R.P-__psid
I,�;� o Did not Opea o Leai:ed o
�� � � s-�� � �. rK �,/
� ���/�� r
Mataials
Usod
Test ARet DC-Closed Closed Tight o Opeaed at Opeaed at _�sid
Rtpair Tighi o osid _�sid
RP sid
T'he above is certifiod to be tnu.
Firm Name lI/. /���`� J !� t Catifiod Testc /"�/`� wc ���� S
Firm Address p/�,/z„ � '7� 1 I�/��`� Ti� Cert. Taster No. ��r�°��'' Date // �/ .
Gauge # ���/.I S//7�
llate last accuracy tested ��,�'��
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy