2014_01074 C�iECK UNE:
IRRIGATION x DOMESTIC FIRELINE
BACI�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPOR?
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: II 2� G�V%er,� Pl✓�
The bacl�-flow preveatioa asscmbly detailod below has beea tested aad nlaintain� � nq� bv TNRCC
regulanons aad is cettified to be operating withia accrptable paramcters.
TYPE OF ASSEMBLY
e Reduced Pressvre Priaciple � Pressure Vacui�Breaker
� Double Check Valve o Amiosphere Vacuum Breaker
�
Maaufactsaer �`t' Siu � �
Modei Number LF a a7 M� QT— Locatad At �� "`�'f�`�'� �r�J
s��N�ba O ioz�9
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER
Doubie Check v alve Assembly
ist Check 2nd Chec�: Relief Valve Air Inlet Cbeck Valve
Inical Test -C osed losed Ti t o Opeaed at Opened at nsid
f� `� ❑ - o nsid _nsid
` ��- _�o RP- �'7Dsid �.3
Q�� I,�;� ❑ Did not Opea o Lea� �
airs
and
Materials
Usod
Test After DC-Closed Closed Tight o Opeaed at Opeaed at �sid
Repair Tight ❑ osid ____,osid
RP sid
The above is catifiod to be true.
Firm Name � Catifiad Testa ��� ��`�1
Firm Address O I�U X Z Cat Teste Na DOI�� Date �� ��
� � ��Z7
Gauge # /S J o9 D��7 Z
Date last accuracy tested -�
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy