2014_1006 _
C�IECK ONE:
iRxIGATION DOMESTIC FIRBLINE X
BACI4'LOW PREVENTION ASSEMBLY TES?AND MAINTENANCE REPOR?
NAIv�OF PWS: CITY OF COPPELL
PWS I.D.#
LOCATION OF SERVICE: Estates of Coppell 1007 Indenendence
The bac�low prevmtion assembly detailod below has bean tested aad maintaiaed as requi�sd bv TNRCC
re_sulations and is certified to be operating withia acceptable parameters.
TYPE OF ASSEMBLY
C Reduced Pressure Priaciple e Pressure Vacu�Brealcer
�, Double Check Valve ❑ A�osphae Vacuum Breaker
Manufacnaer
�)Yf K� Size � r
M��N�� 2�otw� ��At lo�� I nd��e,ncr-C�ru.�
Saial Nimmber ��D6�� 1
REDUCED PRESSURE PRINCIPLE ASSEII�LY PRESSURE VACUUM BREAI�R ;
Double Check V 91ve Assembly
lst C6eck 2nd Cbec1: Rdiet Valve Air ldet Check Va1ve
Inidal Test DC-Closed Closod Tight Openod at OQeaed at _nsid
Ti�t �`� Leal:ed ❑ osid ' nsid
R.P-_,_,psid .v �
Leal:ed a � Did not Opea ❑ Leal:ed 0
�� �aad ,
Materials
' . U�
Test Aft,et IK-Closed Clased Tight o Opeaed at Opmed at __�nsid
Repair Tight o nsid osid
RP sid
The above is catifiod to be we. ''
i
FitII1NaffiC1-AFire&Domestic meG't;ng CertifiedT� ' I
g�p�s Po sox 7 9 5 4 8 Cert.Testc No.BP o o i 5 3 s s � Date � � �
Fort Worth Tx 76179
Gauge # 06070576
Date last accuracy tested 12/3/13
White-Customer's Copy Yellow -City Copy Pink-Tester's Copy