2014_1007 ___ __.
C�IBCK ONE:
IRAIGATION DOMESTIC FIRgLINg' X
BAQ4'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAIME OF PWS: CITY OF COPPELL
PWS I.D.#
LOCATION OF S�RVICE: �states of Coppell 1007 Indenendence
The baci,�low prevtntion assembly detailod below has baa tested and maintaiaed � requi�d bv TNRCC
re„�lauons and is catified w be operadng withia acuptable parameters.
TYPE OF ASSEMBLY
e Reduced Pressvre Priaciple � Pressurc Vacu�Breaker
�� Double Chxk Valve ❑ A�osphce Vacuum Breaker
Manufactiazr �YY1e� Siu � ��
Modei lv�ber o�UO �� Located At �� ���/17�1 ,
Serial N�ber � �� 1
REDUCED PRESSURE PRINCIPLE ASSEII�LY PRESSURE VACCTUM BREAI�R
Double Check V alve Assembly
lst C3eck 2nd Checl: Relief 4alve Air ldet Checic Va1ve
Inidal Test DC-Closed losed Tight Opeaed at Opene�at osid ,
Tight �,�J Leal:ed ❑ __nsid _,_nsid ',
RP-�psid �•a' I,
Leal:ed o Did not Opm o Lesi:ed ❑ i,
aad� �
Materiats
' Usod
Test ARet DC-Closed Closod Tight o Opened at Opened at nsid
_�
Repair Tight ❑ �sid osid
RP sid
The above is cerdfied to be true. �
I
Fitm Namel-AFire&Domestic mes''t_;ng Catified Testa ' I
pirm pddress Po Box 7 9 5 4 8 Cat Testc No.BP 0 O 15 3 8 5 Date � /
Fort Worth Tx 76179
Gauge # 06070576
Date lest accuracy tested 12/3/13
White-Customer's Copy Yellow -City Copy Pink-Tester's Capy