2014_1006 C�IECK �NE:
LRRIGATION DOMESTIC gIRg�g" X
BACI4'LOW PREVENTION ASSEMBLY TEST AND MAIIVTENANCE REPORT
NAI�OF PWS: CITY OF COPPELL
PWS I.D.#
LOCATION OF SERVICE:�.s�ates of Coppell 1007 IndeAendence
'The bacl�low pnvmtion assembly detailed below has been testod aad r++a+nta+++e� as iequired by TNRCC
re_�arions and is catified w be operating withia acuptable parameters.
TYPE OF ASSENIBLY
e Reduced Pressure Principle e Pressure Vacu�Bnaker
�Q Double Check Valve O Amaosphere Vacuum Breakar
Manufacnaer �P.� Siu � �,
Model Iv�ber O`�^��� Locaud At ���3 ���,h�l��.�.�C•�� '
Saial N�mmber � �" 1 '
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSiJRE VACLTUM BREAI�R
Double Cbeck v alv�Ass�bly
lst Check 2nd Checl: Relief Valve Air ldet Check Vaive
Inidal Test DC-Closod Closod Ti,ht Openod at Opeaed at _nsid
Ti�t�•� Leal:cd a nsid `nsid
R.P-_psid
Leaked o � � Did not Opea o Leal:ed Q
RePairs i
i
aad I
Maca�iats
. U�
Test Aiter DC-Closed Clasod Tight o Opened at Opeaod at nsid
-�
Repair Tight ❑ _nsid osid ;
RP id
The above is certified to be tnu. '�
�
F1fIIf TT7�CC1-AFire&Domestic Te.s'ting CGtiStd rCStC I
F�p�Po Box 79548 Cat Testallo.BPoois3a5 Da� �� � ti`7
Fort Worth Tx 76179
Gauge # 06070576
Date lest accuracy tested 12/3/13
White-Customer's Copy Yellow -City Copy Pink-TesteNs Copy