2014_1007 __ _ __
C�IECK ONE:
IR.RIGATION DOMESTIC gIgg�g' X
sAc�,ow p�vExriorr�ss�LY�sr.�vn�►nvrEx�rrcE�roRr
NAIv�OF PWS: CITY OF COPPELL
PWS I.D.#
LOCATION OF SERVICE: �states of Coppell 1007 Independence
'Ilie baci�low prevendon assembly detailed below has boen usted aad maintaiaed as requiszd by TNRCC
re_��ations aad is cettified to be opera�ng withia acctptable parameters.
TYPE OF ASSEMBLY
C Reduced Pressure Priaciple e Pressurc Vacuimm Break,er
� Double Check Valve ❑ Atmosphce Vacuum Breaker
Manufact�aer �'Y1�S Siu � �
Model lv�ber �� � Located At (0� � YldP.10`P�1'1C'P.�t CC�
Ser'ral N�mmber �r'J ��D
REDUCED PRESSURE PRINCIPLE ASSEII�LY PRESSURE VACVi1M BRE�►I�R
Double Check V alve Ass�bly
lst C3eck 2nd Cbecl: Relief�alve Air ldet Check Vaive
Inidal Test DC-Closed losed Ti,Qht Opened at Opeacd at _nsid
Ti�ht (,o Leal:ed o _nsid __�nsid '
R.P-_psid !��"' '
Leal:ed o I?id noc Open o Leai:od �
and� �
Materials
' Used
Test ARet IK-Closed Closed Tight a Optaed at Opeaod at _Tsid
Repait Tight a __Dsid osid ;
RP sid '
T�e above is catified to be true.
;
FitII1 NamCl-AFire&Domestic TeG�-'t i ng Cec11$Cd Testa I
F�p�Po sox 79548 Cat TestcNo.sPoois3ss � Date o 7 �
Fort Worth Tx 76179
(iauge # 06070576
Date lest accuracy tested 12/3/13
White-Customer's Copy Yellow -City Copy Pink-Tester's Copy