2014_1117 C�IECK ONE:
IRRIGATION� DOMESTIC FIRELINE
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. # lf1P�t���
LOCATION OF SERVICE: �Z/ 7�°lae����,
The bacl�low preveation assembly detailod below has beea tested aad maintained as required by TNRCC
rcaulauons aad is cerdfied to be operating within ac�eptable paramcters.
TYPE OF ASSEMBLY
e Reduced Pressure Principle e Pressvre Vacu�Breaker
� Doubla Check Valve o Atmosphere Vacuum Breaker
Manufact�aer i'� � Siu
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Model Number �� Located At .l - oX- 7-�
s��r+�va �'b�'S/� �
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Double Check v alve Assembly
lst Check �nd Chec�: Relief Valve Air Inlet Check Va1ve
Inidal Test DC•Closed losed Ti�ht Opeaed at Opened at nsid
Ti�i Leal:ed o �sid _osid
R.P-_psid
C�j`S I,�;� p Did not Opea o Leal:ed O
�P�
and
Materials
Used
Test Af�t DC-Closed Closed Tight o Opeae�at Opeaod at __flsid
Repair TighL � flsid osid
R.P sid
The above is catified to be true.
. �� ��fi'2��/?�
Fnm Name �� Certified Testa ui
Firm A,ddr� /l.� Y��c��_�___c�i�Cat Testc No. 9 Date //��
� ����
Gauge # f�lJ�/���_
llate last accuracy tested /L•�/Z-/,3
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy