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2014_1008
_ __ ___ C�IECK ONE: IRRIGATION DOMESTIC FIRELINE X BACKFLOW YREVENTiON ASSEMBLY TEST AND MAIIVTENANCE REPORT NAIi�OF PWS: CITY OF COPPELL PWS I.D.# LOCATION OF SERVICE: Estates of Coppell 1007 Independence The baci�low prevmtion assembly detailod below has been t�sted and mA�nta+red as required bv TNRCC nauladons aad is certified to be opera�ng withia acceptable parameters. TYPE OF ASSENIBLY C Reduced Pms�e Priaciple e Pressure Vacu�Breaker � Double Check Valve ❑ A�osphtre Vacuum Breaker Manufact�aer ��-S' • Siu �`� n�,,�,� ,/� '"" " ,� � Modollvumber O� 1� LocaudAt p1"�O Li r�vi1�1 (,1� OICI.��e, 1��0'I ' � Saia!N�mmber ' REDUCED PRESSURE PRINC'IP'LE ASSEh�LY PRESSi7RE VACUi1M BREAI�R ' Double Check�alve Ass�bly lst C3eck 2nd Chec1: Relief Valve Air ldet Check Vah►e Iniaal Test DC-Closed Closed Tight Opeaed at Opeae�at esid , Tight �,J Leal:ed a� �❑ �nsid _esid I R.P-_psid L.eal:ed o Did not Opee o Leal:ed ❑ �p�;,� 1 aad � Materials � ' Usod Test Aft,er DC-Closed Clased Tight o Opened at Opmed at nsid -� Repair Tight o nsid osid � RP sid � '� The above is cectified to be truc. i F1imT1amC1-AFire&Domestic mec't;ng Ce�fied'j'e� ' � Firm Addne�s P 0 s ox 7 9 5 4 8 Cert Testc No.BP 0 015 3 8 5 Date J � Fort Worth Tx 76179 (�auge � 06070576 Date lest accuracy tested 12/3/13 White-Customer's Copy Yellow -City Copy Pink-TesteCs Copy