2014-0317 (15) C�IBCK ONE:
IRRIGATION DOMESTIC FIRELINE ��
BACKFLOW PREVENTION ASSEMBLY TES?AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D.#
LOCATION OF SERVICE: �'�� 1"+�ee a-�,� y� ���-�
The bacl�low prevention asscmbly decailod below has beea tested aad ma�ntain� � nq� bv T'NRCC
regularions aad is certified to be operating withia acceptable paramcters.
TYPE OF ASSEMBLY
e Reduced Pressure Priaciple e Pmsure Vacu�Brealcer
� Double Check Valve o Atmosphere Vacuum Breaker
,, /� r i
Maaufactiaer �r�Q-t.� Siu ,.�1
Model N�ber �C Located At 1`�� ���-r ,h �t�l 1T
Scriai Nimiber � � � o��/
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V�CUUM BREAKER
Double Check v alve Assembly
lst Check 2nd Checi: Relief Valve Air Inlet Checic Vaive
Ininal Test DGClosed Closed Ti,Qht � Opened at Opened at nsid
Ti�t ¢ Leal:ed ❑ �sid osid
RP-L�v psid
Leal;ed o �E b Did not Opea o L,eal:ed o
�P�
aad
Mataials
Used
Test After DC-Closcd Closed Tight o Opeaed at Opmad at �nsid
Repair Tight ❑ nsid �osid
R.P sid
The above is cerufied to be We.
� I�vw �/'= Certifiod Testa /,T^I �CP W i � �
Firm Name ���� �'"`r•�
Firm Address� '�i�+ ��1 �� �''��`�`�`'`r,h� ►�ert TestcNo.g�'t�D�1c�Z D�1 �` � (� f`�
(�suge # ��(�`-� 1���
llate last accuracy tested �' �� � L
White - Customer's Copy Yellow - City Copy Pink-Tester's Copy