2014_1006 _
C�IBCK �NE:
IRBIGATION DOMESTIC FIggI,�iE` X
BACI�'LOW PREVENTION ASSEMBLY TEST AND MAIN'TENANCE REPORT
NAIv�OF PWS: CITY OF COPPELL
PWS I.D.#
LOCATION OFSERVICE: Estates of Coppell 1007 Independence
'Ibe bacl�low prevendon assembly detailed below has bem teste� and mainrain� � nq� bv TNRCC
resularions and is certified to be operating within acuptable parameters.
TYPE OF ASSEMBLY
C Reduced Pressure Priaciple � Pressure Vacuimm Breaker
�j Double Check Valve ❑ A�osphere Vacu�mm Breaker
Maaufactiaer �Y'Y1�3 Siu � �,
Model Ivumber o�-()�U U Locate�At �1)3� ���PG�4'lfk�
Serial N�ber 1 t, n�5
REDUCED PRESSURE PRINCIPLE ASSEII�LY PRESSURE VAC'UiJM BREAI�R '
Double Check�alve Ass�bly '
lst C3eck 2nd Cbeci: Relief Valve Air Ielet Cheek Valve
Inival Test DC-Closed osed Tight Opmed at Opeaed at nsid
Tight a,� Leal:ed ❑ Dsid �nsid
R.P-__psid
Lta(;ed o a�� Did not Opea o Leal:ed o
�� {
� �
Materials '
. U�
Test ARer DC-Closed Closod Tight a Opened at Opmod at _�sid
Repair Tight a _nsid osid
RP sid
The above is certified to be tiue.
C'nrhi n Mover 1��� I
Fiffi1NamC1-AFire&Domestic T -�G't-ing CCRtfitd?CStC � ,
FjtIIlA�sPO BOx 79548 CCti,'ra�CCNO.BPoois3s5 Datc �0�6
Fort Worth Tx 76179
(3auge # 06070576
Date last accuracy tested 12/3/13
White-Customer's Copy Yellow -City Copy Pink-TesteNs Copy