2014_1007 C�IECK ONE:
IRRIGATION DOMESTIC FIRg�g" X
BACKFLOW PREVENTION ASSEMBLY TES'T AND MAINTENANCE REPORT
NAIvME OF PWS: CITY OF COPPELL
PWS I.D.#
LOCATION OF SERVICE:_��_�ates of Coppell 1007 Independence
The baci�low prevmtion assembly detailod below has becn trsted aad maintained as required by TNRCC
re_�lations ead is cartified to be operating withia acccptable parameters.
TYPE OF ASSEMBLY
e Reduced Pnssvrc Priaciple � Pressure Vacuimm Breaker
�i1 Double Check Valve ❑ A�ospber�Vacu�Breaker
M���a ,�ie� s� l''
Modei Number &DU� Locaud At �� � �VL�P.I,�OCn.[J� �.1'A�C�
Serial N�mmber � �.t I�S 1
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUiJM BRFAKER
Doubie Check�alve Assembly
lst C3eck 2nd Checl: Relief�alve Air Ielet Check Vaive
Inidal Test DC-Closcd losed Ti,Qht Opeaod at Opened at �sid ;
Tight �,o Leal:ed ❑ �sid __osid ',
RP-l�sid �.a'
Lealued a Did not Open ❑ Leai:ed o
g�air+c 1
and �
Materials '
' Uscd
Tcst Aft,et DC-Closed Closed Tight o Opeaed at Opeaad at _�os�d ;
Repair Tight ❑ nsid osid ',
RP sid '
The above is catified to be�ue.
�
Fitm N�el-AFire&Domes � G''t i ng Cettifitd TestQ ' I
Firm pddr+ess Po Box 7 9 5 4 8 Cert Testa No.BP o o i 5 3 s 5 � Date �� 7
Fort Worth Tx 76179
Gauge # 06070576
Date lest accuracy tested 12/3/13
White-Customer's Copy Yellow -City Copy Pink-TesteCs Copy