2014_1006 C�IECK ONE:
IRRIGATION DOMESTIC FIRELINE X
BACI4'LOW PREVENTION ASSEMBLY TES?AND MAINTENANCE REPORT
NAIvME OF PWS: CITY OF COPPELL
PWS I.D.#
LOCATION OF SERVICE: Estates of Coppell 1007 Independence
The baci�low prevtntion assembly detailed below haz been tested aad maintaiaed as required bv TNRCC
re_�latioas and is certifiad w be operating withia acceptable parameters.
TYPE OF ASSEMBLY
C Reduced Pressure Priaciple ❑ Pressurc Vacut�Break�er
� Double Check Valve o A�osphae Vacunm Breaker
Manufact�a�er ��S Size ���
M��N�� �n� � ��At 103� l nd�,�e��►�.
s«;�N��a 1 l�o� g � ,
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VAC[TUM BREAKER
Double Checic Valve Assembly
lst C6eck 2nd Checl: Relief Valve A'rr Inlet Check Valve
Inidal Test DC-Closed Closcd Tight Opeeed at Opeacd at osid ',
Ti�fit a •�' Leal:td �.,� o nsid �.�nsid ''�
R.P-�psid '��
Leal:ed 0 Did not Opea O Leal:ed O I
i
aad� �
Mataials
- U�
Test AR,et DC-Closed Closed Tight o Opened at Opeaod at _�sid ,
Repait Tight o nsid nsid ;
RP sid '
The above is cartifiod to be otue. '
� I
FitalN�e1-AFire&Domestic mes''t�ng CCcCifiedT� ' I
Fi�AddRss Po sox 7 9 5 4 8 Cat Testc No.BP 0 015 3 8 5 D�( " 4
Fort Worth Tx 76179
(�auge � 06070576
Date last accuracy tested 12/3/13
White-Customer's Copy Yellow -City Copy Pink-Tester's Copy