2014_1008 _ ___ _
C�IECK ONE:
IRRIGATION DO1I�ESTIC FIRBLINE X
BACI�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAIv�OF PWS: CITY OF COPPELL
PWS I.D.#
LOCATION OF SERVICE: Estates of Coppell 1007 Independence
The baci�low prevmtion assembly detailod below has beea tested and ma�n«n� � �q� � �CC
re„sulations and is certifiad to be operadng withia acccptable parameters.
TYPE OF ASSEMHLY
e Reduced Press�ue Priaciple e Pressurc Vacu�Breaker
,f3 Double Chxk Valve ❑ Amiosphere Vacuum Breaker
Manufact�aer �1M'�4 Siu �'"
Model Iv�ber �DU 1.� Located At a� � �`i
Serial N�ber ��3� 1
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUiJM BRE�iI�R '
Double Cbeck v alve Asa�bly
lst C3eck 2nd Chec.l: RelieF Vatve Air ldet Check Vah►e
Inidal Test DC-Closed losed Tight Opened at Opared at �id
Ti�t � .� Leal:od J ❑ nsid _nsid ;
R.P-_psid � • (
Leal;ed a Did not Opea ❑ Leal:ed � ,�
RePaus �
aad � �� � �
Maceriats '
� U�
'Test Aftar DC-Closed Closed Tight o Opened at Opeaod at _�sid ;
Repair Tight o �nsid osid ;
RP sid '
The above is catified to be tnie.
;
FiTmNamel-AFire&Domestic TPG't�ng CCrtifltdTCStC I
Firm pdd�ss P o B o x 7 9 5 4 8 Cat T�No.BP o o i 5 3 s 5 Date'�
Fort Worth Tx 76179
Gauge # 06070576
Date last accuracy tested 12/3/13
White-Customer's Copy Yellow -City Copy Pink-TesteCs Copy