2014_1008 C�IECK ONE:
IRR,IGATION DO1I�ESTIC FIRBLINE' X
BACI�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPOR?
NAIv�OF PWS: CITY OF COPPELL
PWS I.D.#
LOCATION OF SERVICE: _Estates of Coppell 1007 Independence
The baci�low prevention assembly derailod below has baa usted and maintaine� as required by TNRCC
re_s�ladons and is certified to be operaung withia acceptable parameters.
TYPE OF ASSEMHLY
C Reduced Pressvre Priaciple e Pressure Vacu�Br�akrr
)$ Double Check Valve o Atmosphere Vacuum Breaker
Manufact�aer S Siu � ��
Model Number �v V 1� Locatod At �7� �� � �a'��
Scrial N�ber 1�1� 1 '
REDUCED PRESSURE PRINCIPLE ASSEII�LY PRESSURE VACUUM BREAI�R '
Double Check V alve Ass�bly
lst C3eck 2nd Checl: Relief v alve Air Inlet Check Valve
Inidal Test DC-Closed Closed Tight Opened at Opeaal at _�sid
Ti�tt �,�$ Leal:td ❑ nsid _nsid
R.P-_psid ;
Leal:ed � � .� Did not Opea ❑ LeaZ:ed � ,
aad� �
Materials '
' Usod
Test AR,er DC-Closed Closad Tight o Opeaed at Opeaod at nsid
-�
Repair Tight a �sid osid
RP' sid
The abov�is cartified to be�ve.
i
Fiim Na�C1—AFire&Domestic TPG''ting CGtifit�Tester ' I
F�p��Po sox 79548 CatT�No.sPoois3s5 Datc�° �' C
Fort Worth Tx 76179
Gauge # 06070576
Date 18st accuracy tested 12/3/13
White-Customer's Copy Yellow -City Copy Pink-TesteCs Copy