2014_1008 ___ _
C�IBCK �NE:
IRR,IGATION DOMESTIC gIgg�g' X
BACI�LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPOR?
NA1�tE OF PWS: CITY OF COPPELL
PWS I.D.#
LOCATION OF SERVICE: Estates of Coppell 1007 Inde�endence
13e baci�flow prevendon assembly detailod below has bxa tested aad fiA�nia+red as requised by TNRCC
n�ladons and is catified w be opecating withia accrptable parametas.
TYPE OF ASSEMBLY
C Rtduced Press�e Priaciple ❑ Pressurc Vacu�Brealcer
� Double Chcck Valve ❑ Amiosphere Vacuimm Breaker
Maaufact�er �CW1'es Siu �`�
Modcllvumber o�D � � LocaudAt al.e d Lt �'�f/�til
s�;�N��a 13�t o� �
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACULTM BREAI�R
Double Cbeck�alve Ass�bly
lst C3eck 2nd Cl�ecl: Rdief v alve Air ldet Chec{c Vaive '
Inidal Test DC-Closed losed Ti,pht Opmed at Opene�at _osid �
Tight a O Leal:ed �,a o nsid _esid ',
R.P-_psid I
L,eal:ed ❑ Did not Opea ❑ Lesi►ed o i
aad� �
Materials '
- U�
Test After DC-Closed Closed Tight o Opened at Openod at nsid ,
Repair Tight a nsid osid ';
RP sid '
�
The above is cerdfied w be erue. '�
i
FiiID N�C1-AFire&Domestic Tes''t_ing Certi�ied T� ' I
Fi�m pddc+�s Po Box 7 9 5 4 8 Cat Testc No.BP 0 015 3 8 5 Da� /� a 1 .
Fort Worth Tx 76179
(�auge # 06070576
Date last accuracy tested 12/3/13
White-Customer's Copy Yellow -City Copy Pink-Tester's Copy