2014_1008 ___
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C�IBCK �NB:
LRR.IGATION DOMESTIC FIRBLINE X
BACKFLOW PREVENTIUN ASSEMBLY TEST AND MAINTENANCE REPOR?
NAME OF PWS: CITY OF COPPELL
PWS I.D.#
LOCATION OF SERVICE: Estates of Coppell 1007 Indeuendence
The baci�]ow preveadon asscmbly detailed below has bxa tested aad main�ai�� � nq� � 'I'NRCC
rezulations aad is cctifiad w be operating within acceptable parameters.
TYPE OF ASSENNIBLY
C Reduced Press�e Principle e Pressure Vacu�Breaicer
>!9 Double Check Valve o Anmosphere Vacuum Bnaker
I ��
Manufact�er �'ci�Y1eS Siu
Model Number ��U1j Locate�At �'G,� Lt hC�1'�
Serial Ntimmber �r'J � U1 1 '
REDUCED PRESSURE PRINCIPLE ASSEII�LY PRESSURE VACCTUM BREAI�R '
Doubfe Check�alve Ass�bly '
lst C3eck 2nd C6ecl: 'ef Valve Air Inlet C3eck Valve
Inidal Test DC-Closed osed Tight Opened at Opeacd at nsid ',
Tight f.� Leai►od ❑ nsid _nsid �'
R.P-_psid �(A '
Leal:ed a Did not Opea ❑ Lesi:ed ❑
RePairs i
aad �� � 1
MateriaLs
' Usod
Test Aftet DC-Closed Closod Tight o ppened at Opeaad at _�d ,
Repair Tight a __nsid osid ;
RP sid
The above is ceitified to be onu.
� �
FitmNamel-AFire&Domestic TPG''t;ng CCRifitdTest� I
Firm Addcess Po Box 7 9 5 4 8 Cert'fester No.BP 0 O 15 3 8 5 Date � '� � �/
Fort Worth Tx 76179
Gauge # 06070576
Date Iast accuracy tested 12/3/13
White-Customer's Copy Yellow -City Copy Pink-TesteCs Copy