2014_1007 _ __
C�IECK ONE:
IRRIGATION DOMESTIC gIRg�g" X
BACI4'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAIvME OF PWS: CITY OF COPPELL
PWS I.D.#
LOCATION OF SERVICE: Estates of Coppell 1007 Independence
Tbe baci�low prevendon assembly detailed below has baa tested and maintained as required by INRCC
regttiadons and is crrtified w be operating withia acceptable parameters.
TYPE OF ASSEMBLY
c Reduced Pressure Priaciple e Pressure Vacv�Bn,alcer
� Double Cheek Valve ❑ Amiosphere Vacuum Breakec
Maaufacnaer �e S Siu � •,
ModelIvumber �UU(� LocaudAt �0(�� � I'1G.�F,IJGVIL�.@.I'�LL GI�Yet�.
� �f
Serial Nimmber �J�6�-- ,
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V�CUI1M BREAI�R
Double Check Valve Assembly ',
lst C3eck 2nd Cbecl: Relief Valve Air ldet C6eck Valve '
Inidal Test DC-Closcd los�d Tight Opeaed at Opene�at _nsid
Tight �•�f Leal:ed a _nsid _nsid
R.P- �sid �, a- ;
L.eaked o Did not Opea ❑ Leal:ed o
and� �
Materials
' Used
Test Aft,er DC-Closed Closed Tight o Opeaed ac Opeaod at _�nsid �;
Repait Tight a __osid osid ',
R.P sid
The above is catified to be true.
� i
Fitm Na�el-AFire&Domestic TPG'"ting Cectifited Testc ' I
g�p�s Po Box 7 9 5 4 8 Cat Tester No.BP o o i s 3 s 5 Date l � 7 I
Fort Worth Tx 76179
Gauge # 06070576
Date last accaracy tested 12/3/13
White-Customer's Copy Yellow -City Copy Pink-TesteCs Copy