2014_1008 C�IECK ONE:
IRRIGATION DOMESTiC FIggLINg' X
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAI►ME OF PWS: CITY UF COPPELL
PWS I.D.#
LOCATION OF SERVICE: Estates of Coppell 1007 Independence
The baci�low preve+�doa assembly detailed beiow has beea usted aad maintain� � nq� � �CC
nsulations and is cardfied w be operating withia acceptable parameters.
TYPE OF ASSEM$LY
C Reduced Prrsst�e Priaciplc e Pressure Vacu�Breaker
�Q Double Check Valve o Amaospbere Vacuum Breaker
Manufacturer KIr111PS Siu ���
Model lv�ber �u� P� �ua At ��.�Z�nd reDe►�d,ene.� - C�ar�e �
Serial N�ber .�,�D ��Z
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSi7RE VACUTJM BREAI�R
Double Checic�alve Assembly
lst Check 2nd CSecl: Relief Valve Air ldet Chec{c Valve '
Inidal Test DGCIos Closed Ti,Qht Opeaod at Opened at _nsid ,
Ti�ht `.� Leal:od� ❑ osid `_nsid I
R.P-__„pstd
Leal;ed o a Did not Opea o Leaked �
RePairs i
aad �
Materials
' Used
Test AR,er DC-Closed Closed Tight o Opened at Opened at _�d ,
Repait Tight ❑ nsid nsid ',
RP sid '
The above is cadfied w be orue.
;
�
Fl[II1N�e1-AFire&Domestic meG''t;ng CCctifiedTest�t '
Firm Address PO Box 7 9 5 4 8 Cert Testc No.BP o o i s 3 a s Date_�
Fort Worth Tx 76179
(Gauge # 06070576
Date lest accuracy tested 12/3/13
White-Customer's Copy Yellow -City Copy PiNc-Tester's Copy