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2015-0130 C�iECK ONE: IRRIGATION DOMESTIC ✓f FIRELINE BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PwS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE: ��C� �V�'�' �C.�V� ��r�I. The bacl�low prevention assembly detaile� below has baa tested aad maintained as required bv TNRCC reguladons and is cerdfied to bc operating withia acceptable parameters. TYPE OF ASSEMBLY e, Raiuced Pressure Principle C Pressure Vacu�Breaker � Double Chcck Valve � Atmosphere Vacuum Breal:er Manufactsaer V� Fl �' � � Siu �`� L� t�o�' � � 4�1� f Modei Nimmber Locatcd At �'v'U��"" ��Cc.c.' �/. /t�"t" r a'��:�!` Scrial N�ber C�O 1�� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER Double Check Valve Assembly lst Check ?ad Checl: Relief Valve Air Inlet Checic Valve Inidal Test DGClosed Closed Ti;ht Opeaed at Opened at _osid Tight Leal:ed ❑ �sid _osid RP-_psid I,�;� ❑ Did not Opea o Leal:ed O RePairs and Mataials Usod Test ARer DC-Closed Closod Tight o Opened at Opeaed at �sid Repair TighL o osid osid R�' sid T'he above is catifiod to be true. � "�t ��-3.,o-..(��erdfie�Testa `��"�v'F'on �iy�n Firm Name� i 5r-,�'� �'i t��c��E°�,�j�,'� FirmAddress �t�C�� ' � �`�-I d.- Cert. TastcNo. `Date �: �-I !�� _f'r,t,;' , `._. V% �'� r K l��.`�:�� (�suge # C� �E �� `� llate last accuracy tested � -x�'j Q - j� White- Customer's Copy Yellow - City Copy Pink-Tester's Copy