2014_1006 __ _ ___
C�IECK ONE:
IRRIGATION DO1ViESTIC FIRgLINE" X
BACI�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPOR?
NAIvME OF PWS: C1TY OF COPPELL
PWS I.D.#
LOCATION OF SERVICE: _�states of Coppell 1007 Independence
The baci,�flow prevmtion assembly detailod below has becn tested aad maintained as required by INRCC
re_�larions and is certified to be operaung withia acceptable parameters.
TYPE OF ASSENIBLY
C Reduced Pressure Priaciple e Pressure Vacuimm Bnaker
,'� Double Chak Valve ❑ Atmospherc Vacuum Breaker
M��� �v�e S s� I`�
Modeilvumber �Ul� f�� LocaudAt �VI $ � hG�PrloP�nd.�nC4 _
Serial N�mmbcr �G� 1
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VAC[TUM BREAI�R '
Double Check V91ve Ass�bly ,
lst Check 2nd Checl: Rdief Valve Air Ialet Check Valve '
Inidal Test DC-Closcd Closod Tight Opened at Opeaed at nsid I
Tight a� �' Leal:ed ❑ _Dsid � nsid ,
RP-_psid �� b
Leal;ed a Did aat Open o Leaiced ❑
and� �
Materials
. U�
Test ARer I�-Clos�d Clased Tight o Opeae�at Opeaed at _T sid ,
Repair Tight o �sid osid ';
R.P sid
The above is catifiad to be true.
i
FumN�el-AFire&Domestic meG'"t_ing CeRifit�lTestet ' I
g�p�s Po sox 7 9 5 4 8 Cert.Testa No.BP o o i s 3 s 5 Date vr � /
Fort Worth Tx 76179
Gauge # 06070576
Date lest accuracy tested 12/3/13
White-Customer's Capy Yellow -City Copy Pink-Tester's Copy