2014_1006 __ _.__.
C�IBCK ONE:
IR.RIGATION DOMESTIC FIRELINS X
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAIiME OF PWS: CITY OF COPPELL
PWS I.D.#
LOCATION OF SERVICE: Estates of Coppell 1007 Independence
Tbe baci�low prevention assembly detailed below has beea tested aad mainta�r� � nq� bv TNRCC
regulations aad is cattifiad to be operating withia acuptable parametas.
TYPE OF ASSEMBLY
e Reduced Pressure Priaciple e Pressnrc Vacu,mm Breaker
�i Double Chak Valve o Amaosphae Vacuum Breaker
Manufactiaer �j/Y1�P C Siu J ��
Model Iv�ber �DD I�J Locaud At �U ao2 ( Yt.o�.�f.�.�GLP1Z� '
Seriai N�bcr �� (�
REDUCED PRESSURE PRINCII'LE ASSEII�LY PRESSURE VACLIUM BREAI�R
Double Check�alve Ass�bly
lst C3eck 2nd Cbecl: Relief valve Air ldet Chetic Va1ve
Iniaal Test DGClosed Closed Ti,Qht ❑ Optned at Opeae�at osid
,1 Tis,,�t ❑ Leal:cd o osid i_osid '
�� R.P-_psid
Leal;ed a Did aot Opea ❑ I.eal:ed �
RePain �
aad '� � � �fi Cc�t,/ ��s ye Yc. lc�.c.eJ1 1
Maceriats
' Usod
Test Aft�er DC-Closed Closed Tigbt o Opened at Opmod at _�nsrd !
Repair Tight o osid osid !,
RP id
The above is catifiod to be uve. � '�
Fita1 Na�l-AFire&Domest;c-___._T�G't ing Ceatified T� �
g�p�s Po Box 7 9 5 4 8 Cert.Testa No.sP o o�5 3 s s Date
Fort Worth Tx 76179
Gauge � 06070576
Date lest accuracy tested 12/3/13
White—Customer's Copy Yellow —City Copy Pink—TesteCs Copy