2014_1007 _ _ _
_ ___
C�IECK ONE:
IR$IGATION DOMESTIC FIRELINE� X
BAQ4'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D.#
LOCATION OF SERVICE: Estates of Coppell 1007 Indenendence
The bacl�]ow prevmtion assembly detailed below has been t�sted and r'+A�nr��red as required by TNRCC
re_sularioas and is catified to be operaung withia acccptable parameters.
TYPE OF ASSEMBLY
C Reduced Pressure Priaciple e Pressure Vacuimm Br�aker
� Double Check Valve ❑ Amiosphae Vacuum Breaker
ii
Manufactm�er r Siu �
Model Ivumber �� � Locaud At ��0 7 � Y�C/l�i�l ,
Saial N�mmber 6�J�PO} 1
REDUCED PRESSURE PRINCa'LE ASSEII�LY PRESSURE VACLTUM BREAI�R
Double C6eck�alve Ass�bly '
lst C3eck 2nd Checf: Relief Valve Air Inlet Q�eck Valve '
Inidal Test DC-Closcd losed Tight Opened at Opencd at _nsid �
Tight �•� Leakcd ❑ nsid _,�id I
RP-�psid ��� '
Ltal;ed � Did not Opm o Leai:ed o II
and� �, � �
Materials
' Usod
Test ARar DGClosed Closed Tight o Opene�at Opeaod at _�sid '
Rtpair Tight o �sid osid ,
R.P sid '
The above is cati6ed to be t:ve.
:
FilIDN�C1-AFire&Domestic TPc'ting CC[tifiedTCSStG I
Firm pddc+esa Po sox 7 9 5 4 8 Cert.Testa No.BP 0 015 3 8 5 D���
Fort Worth Tx 76179
Gauge # 06070576
Date lest accuracy tested 12/3/13
White-Customer's Copy Yellow -City Copy Pink-Tester's Copy