2014-0612 (7) C�IECK �NE:
LRRIGATION ✓ DOMESTIC FIRELINB�
BACI�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAIv�OF PWS: CITY OF COPPELL
PWS I.D.#
LOCATION OF SERVICE: I�Sr '�i�e+�DOrZ� l'�y
The bac�low pnveation assembly decaile� below has beea tested and maintained as required by TNRCC
reguladons and is cetified W be operating withia acceptable parameters.
TYPE OF ASSEMBLY
C Reduced Press�re Priaciple � Pressure Vacu�Breaker
� Double Check Valve o Amiosphere Vacuum Breaker
Manufactiaer
l��s s� 2"
Model Number ���1'I'1� Lacated At �t7" o� so cc¢-h P�.S� en��M Nt.e.
Serial Niaaber IQ ��Z N9GTe� �1001032
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Double Cheek Valve Assembly
lst Check 2nd Check Rdief Valve Air Inlet C6eck Valve
Inidal Test DGClosed Closed Tight Opened at Opened at osid
Ti�t Leaked o- osid nsid
�,0�3 RP- 2, sid 2 i.3 ,
I,�;� ❑ Did not Open o Lea1;e� ❑
aad�
Materials ����
Usod
Test ARer DC-Clased Closed Tight o Opeaod at Opmad at ��sid
Repair Tight o �sid nsid
RP sid
The above is certified to be true.
Firm Name��'1OQ,�� Gl S/� _ CatiSod Tester �� ,Kr �eu �l9��,��ar�
Firm Address ��ZB doZi"eK �—_ Ccrt.Tescer No. OD1SSpS Dace o 3 fl
C.a.�ilc�on� 7x 75��1
ca�e #Dlp4a►S9
llate last accuracy tested 1� �y �
White-Customer's Copy Yellow -City Copy Pink-Tester's Copy