2014-0317 (14) C�IBCK ONE:
IRRIGATION DOMESTIC FIRELINE �
BACIQ�7.OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: ��i����//�' �7��1
The bacl�low prevmtion asscmbly detailed below has beea tested aad ma�nta�n� � nq�� bv TNRCC
reauladons aad is cerdfied to be operating withia acceptable parameters.
TYPE OF ASSEMBLY
e Reduced Pressure Priaciple � Pressure Vacut�Breaker
�' Double Check Valve o Atinosphere Vacuum Breaker
' 1 ,, 3� � , �
Maaufactsaer f�-�r'�e c�► Siu
Model Number �� Located At ��n� C r x�n� r t r► J`�� I-�
s«��N�� �R 1 Z3 r�
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V�CUUM BREAI�R
Double Chetk Valve Ass�bly
lst Checic �nd Checl: Relief Valve Air Inlet Check Valve
Initial Test DGClosed Closed Tight � Opeaed at Opened at nsid
TiQht /� Leal:ed ❑ _�sid �sid
RP-�,psid
�;� ❑ .o?.�� Did not Opea O Lealce� �
��
and
Mataials
Usod
Test ARet DC-Closed Closod Tight o Opeaed at Opeaed at �sid
�g1f 'I'lg� � OSId ��,DSld
� S1d
TI1C SbOVC 1S CCfCIfiEd t0 bC�'lIC.
1y� A ,,� 1
Firm Name ���1��� �/"� �I'b3 Catifiod Testa �v�'� W�� `��s
Firm Address��!�x �7�I�7, �'✓�x���-1,rr�j�Cart. Tester No�n D v�7�o Z Date t('I �"�`
ca� � ��o�� 17�0
Date last accuracy tested .3`"� � - ]�f
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy