2014_1006 C�IECK ONE:
IRxIGATION DOMESTIC FIggJ�g" X
BACI�3,OW PREVENTION ASSEMBLY TEST AND MAINI'ENANCE REPOR?
NAME OF PWS: CITY OF COPPELL
PWS I.D.#
LOCATION OF SERVICE: _Estates of Coppell 1007 Independence
T'he bac�low prevmtion assembly detailed beiow has beea teste� and maintaiaod � required bv INRCC
reg�lations and is cctified to be operating withia acccptable parameters.
TYPE OF ASSENIBLY
e Reduced Pressure Priaciple e Pressure Vacu�Breaker
�, Double Chxk Valve � Atmospherc Vacuimm Breaker
Maaufactiaer �_ Siu ��'
Model lv�ber OWO � Locar�At �33 ��n�X]t r�.Q.vic� C�i0.rG.l��
Seriai Nimmber � � ��0 1
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VAC[T[IM BREAI�R
Double Check Yslve Ass�bly
lst C3eck 2nd Cbecl: Relief Valve Air Inlet Check Valve ,
Iaival Test DC-Closed Closed Tight Openod at Opene�at _osid
Tight o'�•� Leal:e�„y ❑ flsid �_,osid
RP-_psid
Leal:ed o Did not Open O Leal►ed D ,
RtPaus �
aad I
Mace�ials
- U�
Test Aftar DGClosed Closed Tight o Opened at Opmed at _�sid
Repair Tight o �sid osid
RP id
The above is catifiod w be true.
� I
Fiffi!NaIDel-AFire&Domestic Te_G�t�ng CeRified?este� � ' I
g�p�f P o B o x 7 9 5 4 8 Cert Testc No.BP o o i s s s s � Date 10l�
Fort Worth Tx 76179
Gau�e # 06070576
Date lest accuracy tested 12/3/13
White-Customer's Copy Yellaw -City Copy Pink-TesteCs Copy