2014_1008 _ ___
C�IBCK ONE:
IRRIGATION DOMESTIC FIRELINE X
BACt�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORI'
NAIig OF PWS: CITY OF COPPELL
PWS I.D.#
LOCATION OF SERVICE: Estates of Coppell 1007 IndeAendence
'Ibe baci�low prevmtion assembly detailod below has beea tested and maintained as required bv INRCC
reg�iladons and is certified w be operating withia acceptable parameters.
TYPE OF ASSEM$LY
e R,tduced Pressure Priaciple e Pressure Vacu�Br�aker
� Double Check Valve o Amaosphere Vacuum Breaker
Manufactiaer ��S Siu � �
Modei Ivumber �'UDI�� Located At o�� a L-� �.� uY�- q A��� '
Serial N�mmber ' � �� 1 '
REDUCED PRESSURE PRINCIPLE ASSEII�LY PRESSURE VACUIJM BREAI�R '
Double Check�alve Asa�bly
lst C3eck 2nd C3ecl: Relicf Valve Air ldet Check Vaive '
Inidal Test DC-Closed Closed Tight Opencd at Opeaed at nsid 'I
Tight �.'f Lealced� ❑ nsid _osid
R.P-_psid "
I,eal;ed a Did not Open o Leaked ❑
RrPaus �
and 1
Materials '
- U�
Test ARer LK-Closed Closod Tight o Opene�at Opeaod at _�ns�d
Repaic Tight ❑ Dsid osid ;
RP sid
The above is cerdfied to be orue. ;
�
Fitm Naa�el-AFir D ' 'ng Certified Testtt ' I
Firm pddcess P o s o x 7 9 5 4 8 Cat Testa No.Bp 0 015 3 8 5 DtiC L�
Fort Worth Tx 76179
Gauge # 06070576
Date lest accuracy tested 12/3/13
White-Customer's Copy Yellow -City Copy Pink-Tester's Copy