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2014-0620 (11)
�._; , _ _ >. . . . . . C�IECK ONE: IRRIGATION DOMESTIC FIRELINE BACI�ZOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D.# LOCATION OF SERVICE:�M �C. � 1�U�Q��� � �-�'=' S ��'r � P,��� �" The bacl�-tlow preveation asscmbly detailed below has beea tested aad maintain� � nq�� by TNRCC reeulations and is cerdfied to be operating withia acceptable parameters. TYPE OF ASSEMBLY ' e Reduced Pressure Principle e Pressvre Vacu�Breaker � Double Chcck Valvc � Atmosphere Vacuum Bnaker Manufact�er - ) � r �.�., s _ Siu � Model Number �> `� i7� Located At ��c�� � �" ���-�� c} � >> (�`� �, � Sk ���� Serial Nimmber ) �! e�`��i'� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Check Valve Assembly lst Check 2nd Checl: Relief Valve Air Inlet Check Valve Inival Test DGClosed Z `� losed Ti,Pht Opeaed at Opeaed at nsid Tight Leal:ed ❑ nsid nsid R.P-_psid `���7 �;� p Did not Opea o Leal:ed O Repairs and Mataials Used Test ARer DGClosed Closed Tight o Opeacd at Opmed at nsid Repair Ti,Qht ❑ nsid osid RP sid The above is catified to be true. �., , • F�+�.j,/ i �"6�t�,'` ��f��� , f-..,=f,.��(4;'L'�,.�.:i . �..1 '��...{., ��\�,�; a�.4..d i;° [t+ � Fum Name � � t Certifiod Tester , �`,'� , . ; Firm Address �";; �`'3^'� `7 � �'`>� � Cert. Tester No. �;r�> � � +.� Date '���� `'i`� �� � ; ,� �,`t,1 �;:ti�,1, ,��' ! ���t, f��;j`:7 � I � � Gauge # ; ��'� ° `" llate last accuracy tested � f� White- Customer's Copy Yellaw - City Copy Pink-Tester's Copy _ _ _ __ . _ _ . _ _ _