2014_1008 C�IBCK ONE:
IRRIGATION DOMESTIC FIRgLINg" X
BACI�'LOW PREVENTION ASSEMBLY TES'T AND MAINTENANCE REPORT
NAIi�OF PWS: CITY OF COPPELL
PWS I.D.#
LOCATIONOFSERVICE: Estates of Coppell 1007 IndeAendence
The bar.�low prevmtion a5sembly derailod below has beea testod and maintained as iequired by TNRCC
ns�lacions and is cettified w be operating withia acceptable parameters.
TYPE OF ASSEMHLY
C Reduced Pressure Priaciple e Pressure Vacu�Brealcer
D Double Check Valve ❑ Amiosphere Vacuum Breaker
Manufactiaer ��e J Siu ��`
Modei Ivumber a"V1�0 1� Locaud At o��.0 L�l �sPv�-t^ ;
Serial N�mmber b V1� �" 1.
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUIJM BREAI�R
Double Check�alv�Assembly
lst Check 2nd Cbecl: Reliet Valve Air Inlet Check Vah•e '
Iaidal Test DC-Closed losed Tight Opened at Opened at _nsid j
Ti�t �2.'-� � Leal:od ❑ nsid __nsid �
R.P-_psid �.•� �
Leal;ed a Did not Open o Leal;ed a
aad� �� � � �
Macerials
' Used
Tesc AR,er DC-Closed Closed Tighe a Opened ac Opea�d ac ,�sid ,
Repait Tight o _nsid osid '
RP id
The above is catified to be true.
i
Film N�el-AFire&Domestic TPR�'t�ng Cecliftd TCStC I
g�,+d�Po Box 79548 Cat T�st�No.BPoois3s5 Date��
Fort Worth Tx 76179
(�auge # 06070576
Date last accuracy tested 12/3/13
White-Customer's Copy Yellow -City Copy Pink-Tester's Copy