2014_1006 __ __.
_ __
C�IECK ONE:
IRRIGATION DOMESTIC FIRELINE X
BACT4'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPOR?
NAAiME OF PWS: CITY OF COPPELL
PWS I.D.#
LOCATION OF S�RVICE: _Estates of CopAell 1007 Indenendence
'Ibe baci�low prevmtion assembly detailed below has becn tested aad m�ta+*e� as requind b�v TNRCC
regulanons aod is certifiad to be operating withia acccptable parameters.
TYPE OF ASSEN�LY
C Rtduced Pressure Priaciplt e Pressure Vacu�Breaker
� Double Chxk Valve a A�osphae Vacuum Breaker
Manufact�aer �� Siu � t�
Modcl Ivumber �OC� IJ Located At ���� ���-p��P,�tC t
Serial Nimmber � �J��-1 I ''
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUL7M BREAI�R '
Double Check V alve Ass�bly
lst C3eck 2nd Checl: Relief�alve Air Inlet Check Valve
Iniaal rest DC-Closcd Closed Ti,Qht Openod at Opeaed at _nsid ,
Tig}tt �,0 Leal:ed ❑ nsid __nsid ',
R.P-_psid (,�
Leal:ed o Did not Opea ❑ Leal:ed 0 '
1
aad� �
Materials
' Usod
Test ARer DC-Closed Closed Tighc o Opened at ppeaod at �sid
Repair Tight ❑ nsid nsid
RP sid
The above is catifiod to be true. �
;
F�N�C1-AFire&Domestic Tes'ting CCRifiC�Test� � I
g�pd�Po sox 79548 CertTcstcNo.BP0015385 Dace ����1�
Fort Worth Tx 76179
(Gauge # 06070576
Date last accuracy tested 12/3/13
White-Customer's Copy Yellow -City Copy Pink-Tester's Copy