2014_1006 C�IECK ONE:
IRRIGATION DOMESTiC PIRELINE X
BACI�I�OR'PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAI►iME OF PWS: CITY OF COPPELL
PWS I.D.#
LOCATION OFSERVICE: Estates of Coppell 1007 Independence
'Ibe bacl�]ow prevmtion assembly detailed below has been testod aad maintaiaed as requind by TNRCC
re_�lations and is certified to be operating withia acceptable parameters.
TYPE OF ASSENIDLY
C Reduced Pr�ssure Priaciple e Pressurc Vacu�Breaker
� Double Check Valve o Amaospber+�Vacuum Breaker
Manufact�er �?S Siu ��t
Modei Iv�ber d�U��1✓ Located At l04 q 111d�J-Gf'Y,1$Yl Cei '
Serial N�ber (?1�I�� 1 '
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACLTUM BREAI�R
Doubte Check�alve Ass�biy
lst C3eck 2nd Cbecl: Relief Valve Air ldet Check Vah•e
Inidal?est DC-Closcd loscd Tight Opened at Opeaed at _nsid ,
Tigi�t �•° Leal:ed �� ❑ nsid _.�osid ',
R.P-_psid
Leaked a Did aot Open ❑ Leal:ed �
g�� 1
aad �
Macerials
' Usod
Test ARtr DC-Closed Closod Tight o Opened at Opeeed at nsid
r
_.--
Repair Tight ❑ nsid osid
RP id '
The above is catified to be true. '
�
F1tmNamC1-AFire&Domestic mes'ting CCc13$CdTe� I
Fi�m pddcets Po Box 7 9 5 4 8 Cat Testc No.BP o o i 5 3 s s Date � b !`�
Fort Worth Tx 76179
(3auge # 06070576
Date last accuracy tested 12/3/13
White-Customer's Copy Yellow -City Copy Pink-Tester's Copy