2014_1008 ____ ___.
C�IECK ONE:
IRR,IGATION DOMESTIC FIR$LINE X
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPOR?
NAIME OF PWS: CITY OF COPPELL
PWS I.D.#
LOCATION OF SERVICE:���ates of Coppell 1007 Independence
The bac�low preventioa assembly detailed below has bxa testod and maintaiaed as required by TNRCC
re_�ations and is certified to be operating withia accaptable parameters.
TYPE OF ASSEMBLY
❑ Reduced Pressurc Priaciple � Pressuro Vac��mm Brealcer
� Double Check Valve ❑ Amaospharc Vacuum Breaker
i�
Maaufactiatr �YYtt� Siu �
��N�a aono � ��At aN� [;�►�
Serial Ntmmber Q1��1�
REDUCED PRESSURE PRINCIP'LE ASSEMBLY PRESSURE V�CtJiJM BREAI�R
Double Check Valve Asaembly
lst C3eck 2nd Cbecf: Relief Valve Air ldet Check Valve '
Inidal Test DC-Closed Closed Tight Opcned at Opencd at nsid ,
Ti�ht /�.o Leal:ed ❑ nsid _.osid ,
R.P-_psid �} ,
Leal;ed o � Did not Open o Leal:ed o
RePairs �
� I
Materials
• U�
Tcst AR,er DC-Closed Closed Tight o Opened at Opraed at _Tsid ,
Repait Tight a nsid osid ';
RP sid '
The above is cerdfied to be uve.
�
Fti'IDN�C1-AFire&Domestic mes''t_ing CatifiedT� '
g�pd�PO Box 79548 CatTw�No.BP0015385 Da� u � /�
Fort Worth Tx 76179
Gauge # 06070576
Date lest accuracy tested 12/3/13
White-Customer's Copy Yellow -City Copy Pink-TesteNs Copy