2014_1008 _. ____ _
C�IECK ONE:
IRR,IGATION DOMESTIC FIggLINg" X
BACI�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAI�OF PWS: CITY OF COPPELL
PWS I.D.#
LOCATION OF SERNICE:_�s�ates of Coppell 1007 Independence
T�►e baci�low prevtntion assembly detailed below has baa tested aad maintainpd as nquirod bv 'INRCC
regulations and is certified to be operating withia acceptable parameu:rs.
TYPE OF ASSEMBLY
c Reduced Pressure Priaciple e Pressurc Vacu�mm Breakrr
�) Double Chxk Valve ❑ Amnosphae Vacuum Breaker
Manufact�et �(�;s Size � u
Modei N�ber a��u►J Locat�At �l I L��
Serial Nimmber I�J�-P ��
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Double Cbeck Valve Ass�bly
lst C3eck 2nd Checi: Relief Valve Air ldet Check Valve '
Inidal Test DGClosed Closcd Ti,Qht Opcned at Opared at _nsid
Ti�ht �,� Leal:ed ❑ nsid __nsid
R.P- nsid ( � �
Lealoed a Did not Open ❑ L,eal►ed D I
�� I
� �
Mataials
- U�
Test After DGClosed Clased Tight o Opencd at Opmad at nsid
Repair Tight a �sid osid ;
RP sid '
The above is catifiod to be true. '
� , I
F11�N�C1-AFire&Domestic Tes't i ng CC1tifi0d'rCStC I
m
g�pd�Po Box 7 9 5 4 8 Cat Testc No.BP o o i s 3 s 5 Date � �
Fort Worth Tx 76179
Gauge # 06070576
Date 18st accuracy tested 12/3/13
White-Customer's Capy Yellow -City Copy Pink-Tester's Copy