2014_1008 C�IECK ONE:
IRRIGATION DOMESTIC FIRELINE� X
BACI�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT'
NAIv�OF PWS: CITY OF COPPELL
PWS I.D.#
LOCATION OFSERVICE: Estates of Coppell 1007 Independence
The baci�low prevmuon assembly detailed below bas beea tested aad maintain� � nq� � '�iRCC
re_suladons and is certified to be operating witbia acuptable parameters.
TYPE OF ASSEM$LY
C Reduced Pnssure Principle e Pressure Vacu�Bnaker
�j Double Check Valve ❑ Amiosphtre Vacuum Bnakec
Manufactiaer +tYY1'C-S Siu � '�
Modei lvumber O��� � Located At oZrJ�e � �lit�-{-+r) '
T
Serial N�mmber �l pl f�� '
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUiJM BREAI�R '
Double CLeck�91ve Asse�bly ''
lst C3eck 2nd Checl: ' f Valve Air Ialet Check Va1ve '
Inival Test DGClosed scd Ti,Qht Opened at Opeacd at _nsid '
Tight �•� Leaked ❑ nsid _�sid
R.P-_psid � .�
Leakod a Did not Open ❑ Leaked O
�� i
aad � ��
Mataials '
- U�
Tcst After DC-Closed Clased Tight o Opened at Opeaed at _,�sid ,
Repait Tight ❑ Dsid osid ';
RP sid '
The above is certifiad to be Crue. �
Fitm NaffiC1-AFire&Domestic Tes''ting CCtiSed TCstC i
Fi�an pddras PO Box 7 9 5 4 8 Cat T�No.BP o o i 5 3 s s Date � ��
Fort Worth Tx 76179
Gauge # 06070576
Date last accuracy tested 12/3/13
White-Customer's Copy Yellow -City Copy Pink-Tester's Copy