2015_0220 (2) C�IECK ONE:
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IRRIGATION V DOMESTIC FIRELINE
BACIQ�3.OW PREVENTION ASSEMBLY TEST AND MAIIVT'ENANCE REPORT
NAI�OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: u 7�- ��Ac r Le�r,�f'
The baci.�tlow prcveation assembly detaile� below haz bxn tested aad main a�n� � nq� bv TNRCC
re_Quladons and is certified to be operating within acceptable paramcte,rs.
TYPE OF ASSEMBLY
C Rcduced Pressure Principle � Pressure Vacut�Breaker
� Doublc Check Valvc ❑ Atmosphere Vacuum Breal:er
Maaufact�er ��� � Siu � �`� `
Model N�ber ��O Locaud At �
�w
Serial N�ber 4-�-�.- '1 �-1� �
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V�CUUM BREAKER
Double Check Valv�Assembly
lst Check 2ad Checi: Relief Valve Air Inlet Check Valve
Initial Test DGClosed � •� Closed Tia 't � Opened at Opeaed at nsid
Tisht ¢�C Leal:ed a �sid osid
R.P-_psid
�;� p Did not Opea o I,eal►ed �
RePairs
and
Mataials
Used
Test Aftet DGClosed Closed Tight o Opened at Opeaod at __�sid
Repair Tight ❑ nsid osid
RP sid
The above is cestified to be true.
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Firm Name P��I R�-► �{�- �'r'��{.c��✓LCertified Testa ��-�-/� ( •� ��' �
Firm Address�'�'1 z�.� i�.�C f�C� [�u�- Cat Testa No.-R f��� �l 3� Date Z - �� -� �
'�>�.��-, � �..,� `_7'�,z��
Gauge # � � u t v `� t.�° �J
llate last accuracy tested J ? �7 _ r ,
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy
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