2014_1006 _ _ _ _
C�IBCK ONE:
IRRIGATiON DOMESTIC FIggLINE" X
BACI�LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAI�OF PWS: CITY OF COPPELL
PWS I.D.#
LOCATION OFSERVICE: Estates of Coppell 1007 Independence
The baci�low prevenrion assembly derailed below has ban testod and maintaiaed as requi:zd bv TNRCC
regularions and is catified w be operating within acceptablc parameters.
TYPE OF ASSEN�LY
C Reduced Pnossurc Priaciple e Pressurc Vacuimm Breaker
� Double Chxk Valve o Amaosphae Vacuum Breaker
Manufact�er N1'YI�2 S Siu ��'
�oarl N�� �o+�U�3 �,«�u�At l e�l I � hdeDP,nd.er►Ce.' C�ar��
Scrial N�ber ��D���
REDUCED PRESSURE PRINCIPLE ASSEII�LY PRESSURE VACLTUM BREAI�R '
Double C3ecic V alve Assembly '
lst C3eck 2nd Checi: Relief Valve Air ldet Check Va1ve '
Inidal Test DC-Closod Closed Ti,¢ht Opened at Opeacd at _nsid �
Tight f,c� Leal:ed 1.fo ❑ nsid _nsid
RP-_psid
Leal;ed o Did not Open ❑ Lealced 0
ea
� �
� �
MaceriaLs
. U�
Test ARet DC-Closed Closed Tight o Openod at Opeacd at nsid ',
_�
Repait Tight a Dsid osid '
;
RP sid
The above is certifiad w be true.
i
Fjtn!TT�ffiC�-AFire&Domestic Tes'ting CCCtiflCd TCSStG I
p�p�s PO Box 79548 Cat TestcNo.BP0015385 Da� 1 �/fe//ti/'
�r�rt��_
Fort Worth Tx 76179
(3auge # 06070576
Date last accuracy tested 12/3/13
White-Customer's Copy Yellow -City Copy Pink-Tester's Copy