2014_1006 _ __
C�IECK UNE:
IR.RIGATION DOMESTIC gIRg�g' X
BACI�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAI�OF PWS: CITY OF COPPELL
PWS I.D.#
LOCATION OF SERVICE: t s of Co ell 1007 Inde endence
Tbe bar.�low prevmtion assembly derailed below has been teste� aad ma�nta�n� � �q� bv 'I'NRCC
re�ladons and is ceetified to be operaung withia acccptable parameters.
TYPE OF ASSENNIBLY
� Reduced Pressvre Priaciple e Pressure Vacuimm Breaker
Double Chxk Valve ❑ Atmosphere Vacuum Breaker
��i
Maaufact�r � Siu
Model Iv�btr d'�V� fJ Located At ��� l. ��Ik/YtIU'11C� LJa
Serial N�ber I �I a�'
� �
REDUCED PRESSURE PRINCIPLE ASSEII�LY PRESSURE VACUi1M BREAI�R
Doubie Check V alve Assembly
lst C3eck 2nd C3ecl: 'ef Valve Air ldet Chevc Valve
Inidal Test DC-Closed Closed Tight Opeaod at Opeacd at �sid
Tight a,�� Leal:ed o nsid `_esid
RP-_psid ) ,(�
L.eaked o Did not Opea ❑ Leal:ed o
�� �
and i
Mataials
' Usod
Test AR,er DC-Closed Closed Tight o Opeaed at Opeaod at _�sid ;
Repair Tight ❑ nsid osid ,
RP sid '
The above is ceeti5ed to be trut. '�
;
FitIIlN�l-AFire&Domestic Tes'ting CGCfi0d7tStC! I
Firm pdd�ss Po Box 7 9 5 4 8 Cat Testa No.sP o o i 5 3 s 5 Date( d � �
Fort Worth Tx 76179
Gauge # 06070576 �
Date last accuracy tested 12/3/13
White-Customer's Copy Yellow -City Copy Pink-TesteNs Copy