2014_1007 __ _ _ _
C�IECK ONE:
IR&IGATION DOMESTIC FIRELINE X
BACI�LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAI�OF PWS: CITY OF COPPELL
PWS I.D.#
LOCATION OFSERVICE: Estates of Coppell 1007 Indenendence
The bac�low prevmrion assembly detailed below has been tes�od and ma�nra�n� � nq� �, �CC
regularions and is ce:tified m be operating withia acuptable parameters.
TYPE OF ASSENIBLY
C Reduced Pressure Priaciple e Pressurc Vacu�mm Breaker
� Double Check Valve ❑ Amiosphere Vacuum Bnaker
Maaufact�aer �S Siu ���
�t�i N�� ��4 D r.�ua At I Oy� I nc�e�,n��n�e , '
Serial N�mmber '��d�e1 '
REDUCED PRESSURE PRINCIPLE ASSEII�LY PRESSURE V�CUUM BREAI�R '
Double Check Valve Asaembly
lst C3eck 2nd Cbecl: Relief Valve Air Inlet Check Vaive
Inidal Test DC-Closed loscd Tight Opened at Opeacd at _nsid I
Tight �,c� Leal:ed ,[ ❑ nsid _osid
RP-_psid a `f
L,eaked ❑ Did not Opea ❑ Leal:ed o I
RePaus �
� � �
Materials
' Usod
Tcst AR,et DC-Closed Close�Tight o Opefled at Opmod az _;sid
Repait Tight o osid nsid
RP sid
The above is catifiod to be true. '
i
FttmN�Cl-AFire&Domestic meG''t_ing Ce�tifiedre� �
Firm Address PO sox 7 9 5 4 8 Cert Testa No.BP 0 015 3 8 5 Date��,�
Fort Worth Tx 76179
(Gauge # 06070576
Date]ast acceu�acy tested 12/3/13
White-Customer's Copy Yellow -City Copy Pink-Tester's Copy