2014_1010 C�IECK ONE:
IRRIGATION DOMESTIC FIRELINE ��
BACI�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
N.�ME oF pws: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: 57_� �,_ I L., � �,;�
The bacictlow prevmtion assembly detailed below has beea tested aad maintained as required by TNRCC
reguladons and is cerdfied to be operadng within acceptable paramcters.
TYPE OF ASSEMBLY
e Reduced Pressure Principle e Pressur�Vacu�Breaker
�. Double Check VaIve o Atmosphere Vacuum Breaker
�
.�
Maaufacuaer �w�...p` Siu �
Model Ivumber ��CCca R.� Located At 1Oy� .Z►� ������ �
Serial Nimmber l ��d 1
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER
Double Check Valve Assembly
lst Check 2ad Checl: Relief Valve Air Inlet Check Va1ve
Inidal Test DGClosed Closed Ti,Pht � Opened at Opened at _nsid
Tight � Leal:ed ❑ _flsid __nsid
c�`_� RP- �,Z psid
�;� � 2 -v Did not Opea o Leal:ed �
Repairs
and
Materials
. Used
Test ARer DC-Closed Closed Tight o Opeaed at Opeaed at _,�sid
Repair Tight o nsid osid
RP sid
The above is cerdfial to be true. ��..---
Firm Name ��� � Cectified T
�:� �.) Y�;ry :���, F-� �
Firm Add�+ess In>c.,�.l�i c�.�-�?X�S I t�S�� Cat Testa No. z Date 0-/0-/
Gauge # C�f 1 y:<`�,ln�-
Date last accuracy tested �• '7 1- ly
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy