2014-0620 (7) C�IECK ONE:
IRRIGATION DOMESTIC FIRELINE ,/
BACT�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATIOIv'OF SERVICE: ISYJ S C�/ �`�r��- �rf� 1 Z�� � �Sd�t i3�r }
The bacl�low prevmtion assembly detailed below has baa tested aad maintained as required by TNRCC
re_sulations aad is certified to be operating within accrptable paramtters.
TYPE OF ASSEMBLY
C , Rtduced Press�rc Principlc � Pressure Vacu�mm Breaker
� Doublc Chcck Valve ❑ Atmospherc Vacuum Breal:er ,
Maaufact�aer � � � �� � s Siu � �`1 ,
Model Number `�'S v X '-� Locatcd At al Lr �. 1 � v�v�. ��-, �r J ��I r��
Scrial N�ber ��b Z`i� !
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VA�LJUM BREAI�R
Double Check Valve Assembiy
lst Check 2ad Checl: Relief Valve :�ir Ialet Check Valve
Initial Test DGClosed Z � Closed Tight o ed at Opened at osid
Tidit Leal:ed nsid nsid
RP-_,psid
�;� ❑ v Did not Opea o Leal:ed ❑
��$ � ( :t.. v, s d
� �,4�1-
Mataials ,
Used
Test Aft�er DC-Closed Z � Closod Tight Opmed at Opmed at _nsid
Repair Tight Z � nsid osid
RP sid
The above is cerdfiod to be true.
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Firm Name��i ?vr�_��a� #�.��;, ' �, ��t�-�%:<��; Certifie�Testc � ��c Q�-�,���
Firm Address�� �;� � :i�- � '.� ` Cert. Testar No. ���i' ��� � ''� Date� .��_� y,
�� � �;
, � t ,;::- r x +',:)� . _>
Gauge # � `( ! � �. ,',, '
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Date last accuracy tested ��%~
� I�
White - Customer's Copy Yellow - City Copy Pink-Tester's Copy
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