2014_1007 ___ _____._
C�IECK ONE:
IRItIGATION DOMESTIC FIgg�g" X
BACKFLOW PREVENTIUN ASSEMBLY TEST AND MAINTENANCE REPOR?
NAME OF PWS: CITY OF COPPELL
PWS I.D.#
LOCATION OF SERVICE: Estates of Coppell 1007 Independence
The bacictlow preveadon assembly derailed below has bem tested aad m�fa�rcd as requind bv INRCC
regulauons aad is ceitified w be operating withia acceptable parameters.
TYPE OF ASSEMHLY
C Reduced Pressure Priaciple e Pressurc vacu�mm Breaker
� Double Chock Valve ❑ Auaosphac Vacuum Breaker
Maaufacnaer YIl'II� Siu ( 4
�i N�ba �� �c�a ac l OS'1 �nd�ot,�dene�- �.ru.ae�
. - a
s��x,��a I`�U�I
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V�CUUM BREAKER
Double Check L'slve Assembly
lst Check 2nd C3ecl: Relief Valve Air ldet Cbeck Vah�e '
Inidal Test I?C-Closcd Closed Ti,�hs Openod at Opeaed at �sid ,
Ti�ht I o�P Leal:ed o _„_nsid _nsid ',
R.P-_,�sid l.� ,
L,eal;ed � Did not Opea ❑ Leal►ed o I,
�pAjT! I
� 1
Mataials '
• U�
Test Aftet DC-Closed Closed Tight o Opeaed at Opeaed at _�sid ,
Repair Tight o ,__nsid osid ;
RP sid
�
Tl�e abovc is ce�tified to be�ve.
�
FitmNamel-AFire&Domestic T_eG''ting CC[tified?CstC ' �
Fi�m pdd�ss Po Box 7 9 5 4 8 Cert.Taster No.BP o o i 5 3 s s Date�;g1�
Fort Worth Tx 76179 �
Gauge # 06070576
Date 18st accuracy tested 12/3/13
White-Customer's Copy Yellow -City Copy Pink-TesteNs Copy