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2014-0317 (18)
C�IECK ONE: IRRIGATION DOMESTIC V FIRELINB BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT N�oF Pws: CITY OF COPPELL PWS I.D. # LOCATTON OF SERVICE: LS '� F��:�r�' 1��-u-�-/ The bac�low preveation asscmbly detailed below has bem ttsLed aad ma�ntair� � nq� bv INRCC rergulations aad is cetified w be operating withia acceptable parametcs. TYPE OF ASSEMBLY C Reduced Pressure Principle � Pressure Vacuimm Breaker � Double Chcck Valve o Amnosphere Vacuum Breaker � , � Manufactsaer 1�Jc� �°� Siu Modei N�ber �� � � Locaud At �� ��'N�✓ �'T ✓�e-'�/ Scrial N�ber �.n � i^P� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER Doubie Cherk Valve Assembly lst Check 2nd Checl: Relief Valve Air Inlet Check Valve Inical Test DGClosed Closod Ti,,p.ht � Opened at Opened at esid Ti�t �!' Leal:ed ❑ _�sid �usid R.P-�psid I,�;� ❑ �' g Did not Opea o Leal:ed o �P� aad Mataials Usod Test Aft�x DC-Closed Closed Tight o Opeaed at Opea�at _nsid Repair Tight ❑ osid osid R.P sid The above is certiEod to be true. Firm Name. �G-�o,� '�re t�r-r�� _ Certifiod Testa /"�� �(�111�l I��,N.�- Firm Address p� �o�r ��,� r..'_�=�'�'��,�ert. Testet No. �D�(���'� Date �''� �/�/�� Gauge # Q�0`-, ��c7 llate last accuracy tested�� 1 I'� White- Customer's Copy Yellow - City Copy Pink-Tester's Copy