2014_1007 _ __
C�iECK ONE:
IR.RIGATION DOMESTIC FIRELINS X
BACI4'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAIvME OF PWS: CITY OF COPPELL
PWS I.D.#
LOCATIONOFSERVICE: Estates of Coppell 1007 Indenendence
Tbe bac�low prevention assembly detailod below has beea tested aad maintaincd as roquired bv TNRCC
n�ulabons and is crrafied to be operating within acccptable parametas.
TYPE OF ASSEMBLY
e Reduced Pressure Priaciple e Pressurc vacu�Bnaker
ap Double Check Valve ❑ A�osphere Vacuum Breaker
Maaufacnaer �e� Siu ��,
Modtl Ivumber�� Located At ���3 � ►1o�-(�P�v�d1.�C.� ����
Serial Nimmber � �.l ���O 1
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V�CLTiJM BREAI�R
Doubie Check�alve Ass�bly
lst C3eck 2nd Cbecl: 'ef Valve Air Inlet Cbeck Valve
Inidal Test DC-Closed losed Tight Opmed at Opeaed at �sid ,
Ti�ht Leal�od ❑ �sid �id
R.P- t ,o nsid � •� ,
Lcakod ❑ Did not Open ❑ Lesl:ed o
grPair� 1
aad {
Materiats
' Usod
Test ARet DC-Closed Closed Tight o Opened at Opeaod at _�sid ,
Repait Tight o �sid osid
RP id '
T'he above is certified to be true.
i
Fi[mNa�el-AFire&Domestic TeG'ting Ceatified?estet I
Fi�m pddress Po Box 7 9 5 4 8 Cert Testc No.BP 0 015 3 8 5 D� � � 7l�
Fort Worth Tx 76179
Gauge # 06070576
Dete last accuracy tested 12/3/13
White-Customer's Copy Yellow -City Copy Pink-Tester's Copy