2014_1008 C�IECK ONE:
IRRIGATION DOMESTiC FIRELINE" X
BACIQ�'LOW PREYENfION ASSEMBLY TEST AND MAWTENANCE REPORT
NAIvME OF PWS: CITY OF COPPELL
PWS I.D.#
LOCATION OF SERVICE: Estates of Coppell 1007 Independence
The baci�low pnvmtion asscmbty detailed below has ban tested aad maintaiaed as required bv TNRCC
re_�lations aad is catified to be operating withia acccptable parameta�s.
TYPE OF ASSEMBLY
C Reduced Pressure Priaciple e Pressurc Vacu�Breaker
� Double Check Valve ❑ Amaosphere Vacuam Breaker
Maaufactiaer
� Siu � �•
Modcl Ivumber�D01� Locate�At �N� � '�''""`"1 ;
Serial Nimmber �� � ��J 1
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUi7M BREAI�R ;
Double Check v alve Assembly
lst C3eck 2nd Cbeck Relief Valve Air ldet Check Va1ve
Ininal Test DC-Closq¢ osed Tight Opmed at Opeae�at osid ;
Ti�,ht j� '2 Leal►ed ❑ �nsid _nsid !I
R.P- nsid ,
Leal:ed o � -� `� Did not Opea ❑ Leal:ed ❑ I
RePau�s i
aad . I
Mataials '
. Usod
Test After DC-Closed Closod Tight o Opened at Opeaad at _�sid ';
Repait Tight ❑ __osid osid ',
RP sid
The above is cerdfied to be true.
;
F1tn1 TTaffiC�-AFire&Domestic Tes't ing CCR1fiCd TCStQ � I
Firm pddc�s PO Box 7 9 5 4 8 Cat Testc No.aP o o i 5 3 s 5 Date ;'�� f `"�
Fort Worth Tx 76179
(�auge # 06070576
Date last accuracy tested 12/3/13
White-Customer's Copy Yellow -City Copy Pink-Tester's Copy