2014_1006 __.__
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C�IECK �NE:
IRRIGATION DOME3TIC FIRELINB X
BAC'I�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAI�OF PWS: CITY OF COPPELL
PWS I.D.#
LOCATION OF SERVICE: Estates of Coppell 1007 Independence
Tbe bac.�low pitvmtioa assembly detailed below has baa usted and maintaiaed as requictd by TNRCC
rc_suiations aad is certified to be operating withia accrptable parameters.
TYPE OF ASSEMBLY
e Reduced Pressure Priaciple e Pressure Vacu�Breakec
�I Double Chak Valve � Atmospher�Vacuum Breaker
N __ - ��
Maaufact�er HYT}�,S Siu
Model Ivumber ��0� U Locat�d At (�.�� (hl�20��'1G�P,t�iC� '
Serial Nimmber � �.f.0�� -- ,
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACiTIJM BREAI�R
Double Check V alve Ass�bly
lst C3eck 2nd Checl: Relief Valve Air ldet Check Valve '
Iniaal Test DGCloscd Closed Tight Opeaed at Opened at _osid 'I
Tight�,� Leal:ed ❑ Dsid _�nsid I
RP-_psid �,� ',
Leal;ed � Did not Opea o I,eai►ed ❑
�P� �
and �
Macerials
- Usod
Test Aft,er DC-Closed Closad Tight o Opeaed at heaad at _�sid ,
Repait Tight ❑ nsid nsid ;
RP id '
Tbe above is cerdfied to be true.
;
F'ttm A1a�o1-AFire&Domestic Tes''ting CCRifiOd TCStG � I
Fi�m pddress Po sox 7 9 5 4 8 Cert Testa No.aP o o i s 3 s s Date �� 6 �
Fort Worth Tx 76179
(Gauge # 06070576
Date last accuracy tested 12/3/13
White-Customer's Copy Yellow -City Copy Pink-TesteNs Copy