2014_1006 ___
C�IBCK ONE:
IRRIGATION DOMESTIC FIRELINE X
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAtv�OF PWS: CITY OF COPPELL
PWS I.D.#
LOCATION OF SERVICE: Estates of Coppell 1007 Independence
The baci�llow prevtntion assembly detailed below has been testod aad maintain� � nq� bv TNRCC
regulaiio�s and is ceitified to be operating withia acceptable parameters.
TYPE OF ASSEMBLY
c Reduced Pressure Priaciple e Pressure Vacuimm Bnaker
,� Double Check Valve o Amaosphac Vacuum Breaker
Manufactiaer �� Siu (��
Modei lvumber O VQ� � Locaud At ��� S ��'U��GY��VIC�. '
Serial N�ber �� 0 Q� 1 '
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACLJITM BREAKER
Double Cbeck Valve Ass�bly
lst C3eck 2nd Cbeci: Rdief 4 alve Air ldet C6eck Vaive
Inidal Test DC-Closed Clos�d Ti,Qht Opened at Opened at _nsid
Tight t .�/ Leal:ed�.'� ❑ nsid �nsid ;
R.P-_psid
Leal:ed o Did not Open o Lealced ❑ ;
and� I
Mataials '
' Usod �
Test AB,et DC-Closed Closed Tight o Opeae�at Opeaad at _Tsid ,
Repait Tight o nsid osid ;
RP sid '
The above is catified to be tnu. . . /f , '�
FitII1 NaffiC1-AFire&Domestic c't�ng Ce�tiSted T�
v' � �
pi�p�s PO Box 7 9 5 4 8 Cert.T�No.BP o o i s 3 s 5 Date 1��.
Fort Worth Tx 76179
Gauge # 06070576
Date 18st accuracy tested 12/3/13
White-Customer's Copy Yellow -City Copy Pink-Tester's Copy