2014_1007 __._ _
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C�IECK ONE:
IIi,RIGATION DOMESTIC FIggLINg" X
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAIvME OF PWS: CITY OF COPPELL
PWS I.D.#
LOCATION OF SERVICE: Estates of Coppell 1007 Independence
T'he baci�low prevention assembly detailed below has boea tested and maintained � requiczd by TNRCC
re_�lations and is ceitified to be operating within acccptable parameters.
TYPE OF ASSEMBLY
e Reduced Pmsurc Priaciple e Pressurc Vacuum Brealcer
�j Double Check Valve o Amaosphere Vacuum Breaker
Manufactiaer �YN�S Siu �'�
Model lvumber �'Ub() � Located At 10(0 Jr I hG�.Q,O�K.fi�-Pn�-Ge- �U�'�� '
Serial Ntmmber 1�7 �
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSiJRE VACLTUM BREAI�R
Doubte C3eck v alve Assembiy
lst C3eck 2nd Cbecl: Relief Valve Air ldet Check Vaive
Inival Test DGClosed loscd Ti,pht Opmad at Opeacd at osid
Tis,�t �.� Leal:ed ❑ �sid �id
RP-_psid �'� ,
Leal;ed a Did not Opea ❑ Leal:ed o '
�� �
aad {
Materials
. U�
Test Aftar DC-Closed Clased Tight a ppeaed at Opeeed at _�sid
Repait Tight ❑ �sid osid
RP' sid ':
�
The above is cerdfied to be�rue.
i
F3ffil N8@C?-AFire&Domestic m_eG-=-t ing Ce�tified Testet ' �
Fiim pddtesa Po Box 7 9 5 4 8 Cat Testc No.sP o o i s 3 s s � Date � �
Fort Worth Tx 76179
Gauge # 06070576
Date 18st accuracy tested 12/3/13
White-Customer's Copy Yellow -City Copy Pink-Tester's Copy