2014-0317 (17) C�IECK ONE:
IRRIGATION DOMESTIC FIRELINE
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
N�oF PwS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: �S� �rCeFJ;�/-� a��/
The bacl�low prevmtion assembly detailed below has beea tested aad maintain� � nq� by TNRCC
regulauons and is certified to be operating within acceptable parameters.
TYPE OF ASSEMBLY
C Reduced Pressure Principle ❑ Pressurc Vacu�Breaker
� Double Check Valve ❑ Atmosphere Vacuum Breal:er
Maaufactiaer �f.�'�-�'� Siu � � ,
Mode1 Number �(� 7�1� Located At �,� Cc�.-nr� ���' �'�
s«;�N,�ba h �33�
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACULJM BREAI�R
Double Check v alve Assembly
lst Check 2nd Checi: Relief Valve Air Inlet Check Valve
Ininal Test DGClosed Closed Ti,Pht �l Opened at Opened at osid
Ti � Leal:ed ❑ Dsid _osid
RP�� � sid Z,v
�;� ❑ Did not Opea o Leal:ed �
�P�
and
Materials
Usod
Test After DC-Closed Closed Tight o Opeaed at Opea�at __�sid
Repair Tight o osid osid
R.P sid
The above is catifiod to be ave.
Firm Name B���r ('il� ��''� Certified Testa /"�� ►�-P_ l�); �/i� �'
Firm Address 1�n 1'3� 7�7, G��x�.���,i;�Cat Tester No.��i�oDDv 7v� Date��- - �
Gauge # D���-� �'7`� l�
Date last accuracy tested �`�( ' �'
White - Customer's Copy Yellow - City Copy Pink-Tester's Copy