2014_1008 _ _
CHBCK ONE:
IRRIGATION DOMESTIC FIRgLINE X
BACI4'LOW PREVENTION ASSEMBLY TEST AND MAIIVTENANCE REPORT
rr.�OF Pws: CITY OF COPPELL
PWS I.D.#
LOCATION OF SERVICE: Estates of Coppell 1007 Independence
'I3e bacl�low prevention a�sembly detailed below has becn tested aad maintained as requiied bv TNRCC
regularions and is carified to be operating withia acceptable parameters.
TYPE OF ASSE1vIBLY
C Reduced Pressure Priaciple e Pressurc Vacu�Breaker
�A Double Check Valve ❑ Atmosphae Vacuum Breaker
MaQufact�aer �1�5 Siu 1 •
.
Model Ivumber a�0� � Locaced At �31n Lt I�}eX'�1
Serial N�ber �L� ��-J� 1
REDUCED PRESSURE PRINCIPLE ASSEII�LY PRESSURE VACUUM BREAI�R
Double Check�alve Asa�bly
lst C6eck 2nd Cbeck 'ef Valvt Air Inlet Cbeck Va1ve
Inidal Test DC-Closed Closed Tight Opeaed at Opencd at nsid '
Tight �•J Leal:ed I.b ❑ osid �osid
R.P-wpsid ,
Leal;ed o Did not Open ❑ Leal:ed ❑ I
RePairs �
and � �� � �
Materials
. Used
Tcst Aftar �-Closed Closed Tight o Opeae�at Opeeod at __nsid
Repair Tight ❑ _�sid osid ';
RP sid '
The above is cerdfied to be true. '�
�
Fitm Namel-AFire&Domesti�t ing Certified Tcue I
g�p�s Po sox 7 9 5 4 8 Cerc Testc No.BP o o i s 3 s 5 Date � �
Fort Worth Tx 76179
Gauge # 06070576
Date lest accuracy tested 12/3/13
White-Customer's Copy Yellow -City Copy Pink-Tester's Copy