2014_1007 ___
C�IECK ONE:
IR$IGATION DOMESTIC FIRELINE X
BACI�LOW PREVENTIUN ASSEMBLY TES?AND MAINTENANCE REPORT
NAIvME OF PWS: CITY OF COPPELL
PWS I.D.#
LOCATION OFSERVICE: Estates of Coppell 1007 Independence
The bacl�]ow ptevention assembly detailod below has been testod aad maintaine� as requittd by TNRCC
re_�t�lations aad is certi5ed W be operating withia accrptable parameters.
TYPE OF ASS�LY
C Reduced Pressure P:iaciple e Pressvre Vacutmm Bnaker
� Double Check Valve ❑ A�osphae Vacuum Breaker
MaQufactiaet F�W1P_� Siu ���
Modei Iv�ber a'0�U � Located At C�'rJot �-l �T_
Serial Nimmber (� � �o�11
REDUCED PRESSURE PRINCIPLE ASSEII�LY PRESSiTRE VACUiJM BREAI�R '
Double Cbecic Valve Asa�bly ',
lst C3eck 2nd Cbecl: 'ef Valve Air ldet Check Va1ve '
Inival Test DC-Closed losod Tight Opeaod at Opeaed at _osid '
Tight �•�' Leaked ❑ nsid __nsid i'
�-�S�d a .�
Leal;ed a Did not O�n o Leai;ed o I,
g�� 1
aad �
Materials '
' Usod
Tcst After DC-Closed Closod right o Opeaed at Opeaed at _�sid '
Repair Tight o `Dsid asid
R.p id
The above is cectifiod to be we. �
� I
FitafTT�Cl-AFire&Domestic TP4�t-ing CGtifiEd?� I
Firm pddrcss PO Box 7 9 5 4 8 CerL Testa No.BP 0 015 3 8 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