2015_0202 3���2��
C�IECK ONE:
IRRIGATION DOMESTIC FIRELINE�
BACI�LOW PREVENTION ASSEMBLY TES?AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. # e / V v ��� � �C�
LOCATION OF SERVICE: � a.. e � `�5���`�7
The bacl�low preveation assembly detailod below has beea tested and maintained as required bv TNRCC
reguladons and is certified to be operating within acceptable paramcters.
TYPE OF ASSEMBLY
� Reduced Pressure Principle ❑ Pressurc Vacu�Breaker
� Double Check Valve ❑ Atmosphere Vacuum Breal:er
�� �� ��
Maaufact�er Size
Model Number /��"f Locaud At �e �A
Serial N�ber �/�J�� 1
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Doubk Check Valve Assembly
lst Check 2nd Checi: Relief Valve Air Inlet Check Vaive
Ininal Test DGClosed Closed Ti,�ht Opened at Opeaed at nsid
TiQht Leal:ed o nsid osid
PG,�j5 R.P__psi
�;� ❑ A Did not Opea o Leal:ed �
�P�
and
Mataials
Used
Test Aft�er DC-Closed Closed Tight o ppened at Opeaod at _nsid
Ropair Tight � �sid osid
RP sid
The above is cerdfiod to be true.
Firm Name �ea� .���� �r-o . Certifiod Testa I o� (�S
Firm AddRss P0, �6 G.�;�� ��'� Cert Testar No.� oa r38"r Date 2 �2 —�J�
x . 7r�G�r
Gauge # �����3
llate last accuracy tested -�U ' �
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy