2014_1006 __
_ _
C�IECK ONE:
IRItIGATION DOMESTIC FIRBLINE X
BACKFLOW PREVENTION ASSEMBLY TES?AND MAINTENANCE REPORT
NAIME OF PWS: CITY OF COPPELL
PWS I.D.#
LOCATION OFSERVICE: Estates of Coppell 1007 Independence
The baci�low prevmdon assembly detailed below haz baa tested and maintaiaed as required by TNRCC
re„�lations aad is reni5ed to be aperating withia accrptable parameters.
TYPE OF ASSE1vIDLY
C Reduced Pressure Priaciple e Pressure Vacu�Bnaker
'� Double Chxk Valve ❑ A�ospherc Vacuum Breaker
Manufact�aer i�S,�rr►P�' Size _T
Model Ivumber �UO U Locate�At 10��I I�P,�?.h,rl_��+�!J�S—�
Serial N�mmber �lQ �0�{' ''
REDUCED PRESSURE PRII�ICIPLE ASSEMBLY PRESSURE VACULJM BREAi�R
Double C3eck V alve Assembly
lst C3eck 2nd Checl: Relief Valve Air ldet Check Va1ve '
Inidal Test DGClosed losed Tight Opened at Opened at nsid ,
?ight �•`'� Leal:ed ❑ �sid __�osid
RP-_._.,psid a.`�
L.eal:ed o Did aot Open O Leal:ed � '
�P� i
aad �
Materials '
. U�
Test ARer DC-Closed Closod Tight o Opened at Opeaed at _�sid
Repair Tight ❑ nsid osid ,
RP sid '
�
The above is certi5ed to be uut.
�
Fitaf N�C1-AFire&Domestic meG't ing Caiifitd Testet I
g�p�s PO Box 7 9 5 4 8 Cat Testa No.BP o o i s 3 s s Date �t lelr�/
Fort Worth Tx 76179
Gauge # 06070576
llate last accuracy tested 12/3/13
White-Customer's Capy Yellow -City Copy Pink-TesteCs Copy