2015_0220 (2) C�IECK ONE:
IRRIGATION 1/ DOMESTIC FIRELINE
BACKFZOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAIv�OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATIOIv'OF SERVICE: `��% � C-����.� l����
The bacldlow prevmtion assembly detailed below has baa tested and maiatained as required by TNRCC
regulazions aad is cercified to be operating withia acceptablc paramcters.
TYPE OF ASSEMBLY
C Reduced Pressure Principle C Pressure Vacu�Brealcer
� Double Check VaIve ❑ Amiosphere Vacuum Breaker
Manufact�er ���a c v Siu 3 ��� �r
Model Number � ''� Located At �-c�.� '�`�`.�:-
Scrial N�bcr 1-�{�C ��'! '�� I g`"1
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V�CUUM BREAI�R
Double Check Valv�Assembly
lst Check 2ad Checl: Relief Valve Air Inlet Check Valve
Ininal Test DGClosed 2' Z Closed TiP,ht ¢� Opened at Opeaed at esid
Tisht �C Leal:ed o vsid osid
R.P-_psid
�;� ❑ Did not Opea o Leal:ed o
�P�
and
Mataials
Used
Test ARer DC-Closed Closed Tight o Opened at Opeaed at �sid
Repair Tight a Dsid osid
RP sid
The above is catified to be true.
� ` .
Fiim Na,+,e� d`,M:i�-�' I�L l��'!�� ' �+'�- Ce[ti5od Teslet f--��� �� �[-�-�K c� �il 1
Firm Address Z v � z � �' � � Cat Testc No. a�1 �� Date 2-' � � � �
''-.w--rt �.- J���r��
(�suge # 1 R c,� ► C' �1 � �
llate last accuracy tested / - ? 7-� !5
White - Customer's Copy Yellow - City Copy Pink-Tester's Copy