2014_1007 . ___
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C�IECK ONE:
iRRIGATION DOMESTIC gIRg�g` X
BAC'i�'LOW PREYENTION ASSEMBLY T'EST AND MAINT�NANCE REPORT
NAIiME OF PWS: CITY OF COPPELL
PWS I.D.#
LOCATION OF SERVICE: �states of Coppell 1007 Indenendence
The baci�low prevention assembly detailed below has bean testcd aad maintaiaed as required by TNRCC
re_suladons and is certi5ed to be operating witbin accrptable parameters.
TYPE OF ASSEMBLY
e Reduced Pre�ssure Priaciple ❑ Pressure Vacu�Brealcer
� Double Check Valve o Amsosphae Vacuum Breaker
Maaufacnaer 1"n'nP.g Siu (��
Model lv�ber �.(�U fJ Located At �0'�J� �I1.0�Q-�no(t,h f.�,
Serial Nt�ber � �ab
REDUCED PRESSURE PRINCII'LE ASSEMBLY PRESSURE VACUUM BREAI�R
Double Check Valve Ass�bly '
lst C3eck 2nd Checi: Relief Valve Air ldet Check V91re
Inidal Test DC-Closed osed Ti,Qht Opeaod at Opeaed at _osid ;
Ti�,ht ',�j Leal:td ❑ _nsid _osid I
R.P-_�sid �,�
Leal:ed a Did not Opea o I,eai►ed ❑
1
an�d� �
Materials '
� U�
Test ARar DC-Closed Closed Tight o Opened at Opeaod at _�sid ,
Repait Tight ❑ nsid __�osid ;
RP sid
The above is certified to be true.
�
Fitn!TT�C1-AFire&Domestic mPG''t_;ng CCCtifiOd TC.4iC I
Firm pdd�ess Po Box 7 9 5 4 8 Cert.Testa No.sP o o i s 3 s s Date� �y
Fort Worth Tx 76179
Gsuge # 06070576
DBte lest accuracy tested 12/3/13
White-Customer's Copy Yellow -City Copy Pink-Tester's Copy