2014-0612 (8) CIIECK ONE:
IRRIGATION V DOMESTIC FIRELINE� "
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENA�IVCE REPOR`T
N�OF Pws: CITY OF COPPELL
PWS I.D.#
LOCATION OF SERVICE:�� �/tl�ni2f' ,/'�`zult/
The bacl�low preveation assembly detailed below has bem tested and ma+r a+ned a� requirod by TNRCC
regulazions and is certified to be operating withia acceptabla�arameters.
TYPE OF ASSEMBLY
e Reduced Pressurc Priaciple e Pressure Vacu�un Bresker
� Double Check VaIve o Amiosphere Vacuum Bnaker
'L"
Maaufaci�ucr ��-�-� Siu
Model Number ' 00 rI YYI ( Located At a�l t a� /Vo�-G, Fas� P�+KssN ce
SerialNimmber /�Dy�30
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSiJRE VACUUM BREAI�R
Double Check Valve Assembly
lst Check 2nd Check Relief Vaive Air Inlet Check Va1ve
Inival Test DGClosed Closed Ti,�.ht Opened at Opened at nsid
Ti�l.�t Leal:ed ❑ osid �sid
In I 30 RP- 2,I flsid 2,3
Leaked a Did not Open o Leal;ed o
�P�
� �NN
Materials
Used �
Test After DC-Closed Closed Tight O Opened at Opeaod at _�sid
Repair Tight � osid ____,osid
RP sid
The above is ccrti6ed w be true.
Ficm Naou l_�oQa� L.�.�'A CertiSied Taeer Gl�r lei�IG�-i !'J'Aal'�'!��`�D n
Firm Address_y��8 f�nzlp,� � Gert.Tater No. ODl SSOrS' Date, !��T
Ca�c�eo!I�fO� T . 7 so�►
Gauge # �q 2159
llate last accUracy tested /
a
,,.,
White-Customer's Copy Yellow -City Copy Pink-Tester's Copy