2014-0612 (9) C�IECK ONB:
IRRIGATION ✓ DOMESTIC FIRELINE�
BACI�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAIv�OF PWS: CITY OF COPPELL
PWS I.D.#
LOCATION OF SERVICE: �225 �P��O��G�' �i�.u1 e�
The bacicflow prcvtntion asscmbly detailed below has been tested sad main a�r� � �� �, �CC
reguladons and is certified to be operating within acccptablc parameters.
TYPE OF ASSEMBLY
o / Reduced Pressvre Principle � Pressure Vacu�Bueaker
!Y Double Check Valve ❑ Atmosphere Vacuum Brealxr
r�N
Manufacuu�er .�(�Q� S Size
Model Ivimmber C'O rT II'J I Located At �e� Ot SOt.�{�P./1Sf .[�'1�Y7G�
Serial Nimmber /�D y 4 ? m�� 70o i o30
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V 4C[TUM BREAI�R
Double Check Valve Assembly
lst Check 2nd Checl: Relief Valve Air Iniet Check Valve
Inidal Test DC-Closed Closed Tight Opened at Opeaed at flsid
Tight Leal:ed o __osid �sid
1D�3a R.P-��psid �
r.�:�a � � � 9 �a no�op� o �:�a ❑
��
�d 1�one
Matcrials
Usod
Test ARer DC-Closcd Closed Tight o Opeaed at Opeaed at _nsid
�p� T;g� o �sid nsid
RP sid
The above is certified w be true.
Firm Name ��A�e /,IS� Certifiod Tater �( a/ N�AA2i�✓�+'�
Firm Add�ess �ag � 2 ' c. 2o Cert.Tester No. .PO1SSoS Date /o a
�At.�to!�' �r ^x 7SoN
Gauge # D�oq 215�I
Date last accuracy tested 2 1�
White-Customer's Copy Yellow-City Copy Pink-Tester's Copy
I .