2014_1006 .__ _ __
C�iECK ONE:
IRRIGATION DOMESTIC FIRBLINE' X
BACI4'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAI�OF PWS: CITY OF COPPELL
PWS I.D.#
LOCATION OF SERVICE:_�.s�ates of Coppell 1007 Independence
The baci�low prevention assembly detailed below has been tesied snd mA+nta+*e� as required bv INRCC
regnlations and is ceitified to be opera�ng withia acceptable pA*a•,,r*�,
TYPE OF ASSEMBLY
C Reduced Pressun Priaciple e Pressure Vacuimm Breaker
'S� Double Check Valve � Amiosphere Vacuum Breaker
Manufact�aor Siu
��
Model Ivumber �if'U uV L7 _ Locaud At IN � � �,1(��1'luK/h-tX�Gar�.
Serial N�ber �,�o � ��
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUTIM BREAI�R ',
Double Check Yalve Ass�bly '
lst C3eck 2nd Checl: Retief Valve Air Inlet Check Va1ve
Inidal Test DC-Closed Closed Tight Openod at Opeaed at nsid �
Ti�� Leal:od o nsid ,_,_�osid ,
RP-_psid I
Leal:ed � I' � Did aot Open o Leaf:ed ❑ '
� 1
� �
Maurials
. Usod
Test Aftat DC-Closed Close�Tight o Opened at Openad at nsid '
—�
Repair Tight o �nsid osid ',
RP sid '
The above is catificd to be we. � !
�
Fltn!N�C1-AFire&Domestic Tes't�ng Cel�ifit�T� I
g�p�sPo Box 79548 CatTestcNo.BPoois�s5 Da� �D
Fort Worth Tx 76179
(�auge # 06070576
Date last accuracy tested 12/3/13
White—Customer's Copy Yellow —City Copy Pink—Tester's Copy