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2015_1001 ;:.� C�IECK ONE: � IRRIGATION �+�'` DOMESTIC FIRELINE BACI{FT�OW PREVENTION ASSEMBLY TES?AND MAINTENANCE REPOR? NAME OF PWS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE: � � �"�� ' ` � .-�-� The bacl�low prevmtion assembly detailed beIow has bcea tested aad maintained as required by TNRCC reguladons aad is certified W be operating withia accrptable parameters. TYPE OF ASSEMBLY �e Reduced Pressure Principle � Pressure Vacuimi Brealcer Double Check Valve o Amiospherc Vacuum Breaker F' � ''�, Siu .e. �✓ : Maaufactsaer �` �' - c�I __ " "Tviodel Iv�ber Located AL -,>' '"U � / . r'�- - Serial N�ber �� ' `� � REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V�CUUM BREAI�R • Double Check Valve Assembly lst Check 2ud Checl: Relief Valve Air Inlet Check Valve Initial Test DGClosed �%a � losed Ti�it Opeaed at Opened at osid Ti�t Leal:ed ❑ csid �osid RP-_psid I,ealced a Did not Opea o L,eal:ed O �P� and Materials Used Test After DC-Closed Closed Tight o Opeaed at Opeaad at _�sid Repair TighL q osid _,_osid RP sid The above is certified to be true. r�. . . ,s__., �. ��" Firm Name ��'�'''�S�n`� Certified Testa` �� '� C l'� � �,�!�'��_, _ - �, { .�-- .�, _ .- • „ �, ;..r, �:�pi Date.f�°,. - �'-� ,/ '�'- Firm Addressl��'.�- �/C �� ''��' �`' �. Cat Testc No... nG . . Ga e ,,._� �._ � . � ��.- � � �' � �T,-� llate last accuracy tested White- Customer's Copy Yellow - City Copy Pink-Tester's Copy