2014_1008 ._. _ __
C�IBCK ONE:
IRItIGATION DOMESTIC FIRELINE X
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D.#
LOCATION OFSERVICE: Estates of Coppell 1007 Independence
The baci;flow ptzvmtion asscmbly decailed below has bxn teste� aad maintaiaed as required by TNRCC
rzgulations and is certi5od w be operating withia acuptable parameters.
TYPE OF ASSEMBLY
e Reduced Pr+essurc Priaciple e Pressurc Vacu�Bnaker
� Double Chxk Valve o A�osphere Vacuum Breaker
Manufact�aer Q�,M�S Siu �`�
Model Ivumber o��� Locaud At ��- �-1�(�-�
Scrial N�mmber �U�DU � '
REDUCED PRESSURE PRINCII'LE ASSEMBLY PRESSURE VACUi1M BREAI�R '
Double Check�alve Ass�bly
lst C3eck 2ad Cbeci: Relief Valve Air ldet Check Valve
Inival Test DGClosed losed Tight Opmed at Opened at _nsid ;
Tis„��t � � Leal:cd ❑ nsid _nsid '
R.P-_psid
L,eal;ed a �° Did noc Open ❑ Lrai:ed ❑ i
�p� I
and �� �
Materials '
' Usod
Test Aftet DC-Closed Closed Tight o Opeaed ac Opeaod at _Tsid
Repsir Tight ❑ nsid osid ,
RP id '
The above is certified to be uut.
;
FitmNa�l-AFire&Domestic me�''t;ng Ceztifie�Tester I
Firm Address P O B o x 7 9 5 4 8 Cat Testa No.sP o o i 5 3 s 5 Date ` `��� �`�
Fort Worth Tx 76179
Gauge # 06070576
Date lest accaracy tested 12/3/13
White-Customer's Copy Yellow -City Copy Pink-Tester's Copy