2014_1007 __
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C�IECK ONE:
IRRIGATiON DOMESTIC FIRELINE X
BACI�LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAIv�OF PWS: CITY OF COPPELL
PWS I.D.#
LOCATION OF SERVICE: Es�ates of Coppell 1007 Independence
The bac�low prevention assembly detailod below has baa tested aad maintained as requittd bv TNRCC
regulaboas and is certified to be operating withia acuptable parameters.
TYPE OF ASSENN�LY
C Reduced Pr�ssvre Priaciple e Pressvrr Vacu�Breaktr
� Double Check Valve o Amaospher�Vacuum Bnaker
Maaufacnaer �YY1� 5iu � a
Model Itiumber �� � Locaud At �b�1 L rU��h(�
Serial N�ber ��� �S
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACLTUM BREAI�R
Doubte Check�alve Assembiy
lst Check 2nd Checl: Relief Valve Air ldet Check Vah►e
Inidal Test DC-Closed Closed Tight p' Opeeod at Opeae�at osid
Ti�ht /.� t� Leal:td ❑ nsid _Tnsid
R.P-_psid �, a-
L,eaked a Did aot Open ❑ Leaked o '
RePairs
aad � � �
Mataials
. U�
Test AR�er DC-Closed Closod Tight o Opened at Opeaod at _flsid ,
Repair Tight ❑ �sid osid
;
RP id
The above is certifiod w be aue. '�
�
Fitn]Na�el-AFire&Domest�r�_��G't ing Ca'tified T� �
Firm pddc��s P o s ox 7 9 5 4 8 Cert Testc No.BP 0 015 3 8 5 Date t � 7
Fort Worth Tx 76179
Gauge # 06070576
Date lest accuracy tested 12/3/13
White-Customer's Copy Yellow -City Copy Pink-TesteCs Copy