2014_1006 _ __. _ _
C�IECK ONE:
IRRIGATION DOMESTIC .FIRELINE' X
BACI�'LOW PREVENTION ASSEMBLY TES?AND MAIlVT'ENANCE REPORT
NAIvME OF PWS: CITY OF COPPELL
PWS I.D.#
LOCATION OFSERVICE: Estates of Coppell 1007 Independence
T'he baci�low preveation assembty detailed below haS been teste� and maintaiaod as requi�d bv TNRCC
rt_s�latioas aad is certi5ed to be operating withia acceptable parameters.
TYPE OF ASSENIBLY
C Reduced Prrssure Priaciple e Pressurc Vacu�Breaktt
� Double Check Valve ❑ A�ospherc Vacuum Breaker
I ��
Manufactiaer � Siu
Model Nmuber � U __ Locaud At `�Q ��el�l�C.2. �� '
Serial Nimmber � �� �n
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUi1M BRFAI�R
Double Check�alve Assembly
lst Check 2nd Cbecl: Relief Valve Air ldet Check Va1ve '
Iniaal Test DC-Closed osed Tight Opened at Opeaed at nsid ;
Tight �?•�( Leal:ed ❑ nsid ___osid �I
R.P- osid 1
Ltaked a `�� Did not Opm O Leai�ed ❑ II�
�P� �
� I
Maceria(s
' Used
Test ARer DGClosed Clased Tight o Opeaed at Opmed at esid
Repair Tight ❑ nsid nsid ',
RP sid
The above is cera5ed to be true.
;
Fital N�OfCl-AFire&Domestic meG'"t_ing Ce�tifiai Testet ' '
p�p�s PO Box 79548 Cat T�No.BPoois3s5 Date v a (
Fort Worth Tx 76179
Gauge # 06070576
Date last accuracy tested 12/3/13
White-Customer's Copy Yellow -City Copy Pink-TesteNs Copy