2014_1006 _._.__ __
C�IBCK ONE:
IRItIGATION DOMESTIC FIRgLiNE' X
BACI�Z�OW PREVENTION ASSEMBLY TEST AND MAIIVT'ENANCE REPORT
NAIME OF PWS: CITY OF COPPELL
PWS I.D.#
LOCATION OF SERVICE: Estates of Coppell 1007 Indet�endence
'Ibe baci�low prevendon assembly detailed below has been tested aad maintaiaed as requirod by TNRCC
re„Quladons and is catified to be operating withia acceptable parameters.
TYPE OF ASSEMBLY
e Reduced Pressurc Priaciple e Pressurc Vac1n�Breaker
� Double Check Valve o Amaosphtre Vacuum Breaker
Manufactiaer �� Siu ' M
Model Number a�o D$ Locaced At �n�.-T�-1'Jd�_SQ�t�'Y►Cf l."�,Y��
Serial Nimmber
Ile I bto � ��
REDUCED PRESSURE PRINCIPLE ASSEII�LY PRESSURE VACUiJM BREAI�R
Double Check Valve Assembly
lst C3eck 2nd CLeci: Relief Valve Air Ieilet C7uck Valve
Ininal Test DC-Closed Closed Ti,rht Openod at Opeacd at osid
Tight a Leal:od o nsid o.�nsid
R.P- a_psid �, c�
u� o Did not Opea O Leaked O ,
�P� i
and �
Materials
. U�
Tcst Aftet DC-Closed Closod Tight o Opeaed ac Opeaad at __�d
Repair Tight ❑ nsid osid
RP id
The above is catified to be true. ''�
, � , �
FitmN3me1-AFire&Domestic 'res''ting Ceatified?esta I
F�p�Po Box 79548 Cert T�No.sPoois3ss Date �I e ( �
Fort Worth Tx 76179
(�auge # 06070576
llate last accuracy tested 12/3/13
White-Customer's Copy Yellow -City Copy Pink-Tester's Copy