2015_0220 C�IECK ONE:
IRRIGATION�_ DOMESTIC FIRELINE
BACKF'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPOR?
NA11�OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: �I���►��P �,A�7�
The bacl�low preveation asscmbly detaile� below has beea tested aad maintained as required by TNRCC
regulanons and is certified to be operating within acceptable paramtters.
TYPE OF ASSEMBLY
c Reduced Pressurc Principle � Pressure Vacu�mm Breaker
� Double Check Valve � Atmosphere Vacuum Breaker
Manufact�er �c3 co Siu 31�J. '(
Model Ivimmber g S v Locaud At �����-�-
s«;�N�ba N C 6'D 3q.S
RLDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUI7M BREAKER
Double Check Valve Assembly
lst Cherk 2nd Checl: Relief Valve Air Inl�t Check Valve
Iniaal Test DGCloscd 2•3 Closed Ti�t� � Opened at Opened at osid
Tisht Leal:ed o vsid osid
RP-_psid
�;� p Did not Open o L,eaked �
RePairs
and
Mataials
Used
Test Aft,er DC-Closed Closed Tight o Opened at Opmad at nsid
Repair Tight ❑ �sid osid
RP sid
The above is certified to be tnu.
Firm Name ���;n.) ��ac�l���` Catified Testa h�(.���c..S �t
Firm AddrGss Zv zz l�n�J���k �'� Cert. Tester No.'P�P�3 a Date 2 -=
�oN�� ����
Gauge # t,101 � �-1�0�l
Date last accuracy tested ( � Z? —t S
White - Customer's Copy Yellow - City Copy Pink -Tester's Copy