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2015-0130 (4) C�IBCK ONE: IRRIGATION DOMESTIC FIRELINE ��`' BACI�'LOW PREVENTION ASSEMBLY TES'T AND MAIIV'I'ENANCE REPORT NAI�OF PWS: CITY OF COPPELL PWS I.D. # ... �., ._.., �. -, LOCATION OF SERVICE: T �' / �._ �'`�C'i��tr:��"�" r' y�� r. ..��_ , The bacl�low prevmtion asscmbly detailed below has beea tested and maintained as requirc� by TNRCC reguladons and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY e Reduced Pressure Principle e Pressure vacui�Breaker ?f Double Check Valve o Atmosphere Vacuum Breaker � �, `:'s'�:.r ,i Maaufacaaer �� t'� �1�.� -� Siu i _ • � � -:� �, , . ,. a,.��`th'�..��,�� Locaud At � �, . Model Number ,� - � _ . _. �. _-- • ; r 1 td 1 + f �v �. � �. �.(�;�t� � C7�tJ s�- � �`�-.� -�',�o. ', Serial N�ber .-� � �` � 4 �v� f � , :� �,,` REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double C3eck v alve Assembly lst Check 2nd Checi: Relief Valve Air Inlet Check Vaive Inidal Test DGClosed Closed Ti�ht Opened at Opened at nsid Tight Leal:ed c9"� �nsid �sid R.P-_psid ,�� , j,�;� �-"� '� � ; �i t �<i > . � Did not Opea D Leaked O �; �� 4- ,J S��.; '�..J f \��j� ,. C . t r}'�..`p t,... Y Y ��;�Y-V' �. 3IId ,,,!,-�:: �:C u �1 `'k � . �.l iJ,..7 k.`).,r.� !_`.0 k !;._�� Materials j~�: Used Test Aft�er DC-Closcd Closed Tight Opeaed at Opeaed at _�sid Rcpair Tight �sid _nsid RP sid The above is cerafied to be true. . � � . �_ . - .. - _, Firm Nsme �'�_...��,.r�"`�t-l ��; t��u)�r u .,�,-�CeRi6od Testet �i c-�:'~;�� ,,. ; , . �-- ,` , ,... . �_, ,.., . Firm Address �' �': � � � � , .��. a ��; ��_��.�yl` Cat Taster Na � ,t��" � � =�'` Date �' �- d..�� f �-� ; ��.�X _'�� . � �A:_''�.i,��;'dl,� f , ; G8llge # ..�, ��,, �t`�E f t'.�a��;�� llate last accuracy tested ; - ;;�;- j� White- Customer's Copy Yellow - City Copy Pink-Tester's Copy .