2014_1007 C�IECK ONE:
IRRIGATION DOMESTIC FIRELINE X
BACI�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPOR?
NAIu�OF PWS: CITY OF COPPELL
PWS I.D.#
LOCATION OF SERVICE: Estates of Coppell 1007 Indeuendence
T'he baci�low preveation assembly detailod below has beea tested and maintained as requited bv TNRCC
re„s�lations aad is certi5ed to be operating withia accrptable parameters.
TYPE OF ASSEMBLY
e Reduced Pressiue Priaciple e Pressure Vacvi�Bnaker
� Double Check Valve ❑ Amiosphere Vacuum Breaker
Maaufactiaer L�Y1']� Siu ("
Model N�ber o14 V l� b Locaud At �U S�, �r►L�P.�2�.�t-Q,
, �
ScrialNimmber ��J�P� 0
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUIJM BREAI�R
Double Check Valve Ass�bly
lst C3erk 2nd Cbecl: Relief Valve Air Inlet Check Valve '
Inidal?est DC-Closed Closod Tisht Opened at Opeae�at osid
Ti�t ' � Leal:ed ❑ nsid __nsid
RP-�psid �•�
Leaked a Did noc Opea o Leal:ed ❑
�� 1
aad �
Marerials '
' Usod
Test ARet DC-Closed Closad Tight o Opened at Opeaod at _Tsid ,
Repair Tight ❑ nsid osid ;
RP id '
The above is cerafiad to be true.
� , I
FiiID Namel-AFire&Domestic me4't i ng CCRified Te.tita I
F�p�Po Box 79548 CatTestcNo.BP0015385 D� 0�7 /
Fort Worth Tx 76179
Gauge # 06070576
Date last accuracy tested 12/3/13
White-Customer's Copy Yellow -City Copy Pink-TesteCs Copy