2014_1117 (2) C�IECK ONE:
IRRIGATION DOMESTIC � FIRELINE
BACT4"LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPOR?
NAME OF PWS: CITY OF COPPELL
PWS I.D.# ��P�i1 t�.5
LOCATION OF SERVICE: fti Z% ��l�1��
The bacl�low preveation assembly detailed below has beea tested and main ain� � nq�� bv TNRCC
reguladons and is cerdfied to be operating withia acceptable parameters.
TYPE OF ASSEMBLY
e Reduced Pressure Principle C Pressurc Vacu�Breaker
� Double Check Valve � Amiosphere Vacuum Breal:er
Maaufacnaer �d��t�rirS Siu �/L
Model Ivumber , f� . Located At �.e /' �'.�._ � �.�C�rn�
Serial Nimmber O��5"i��3�7
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Doubie Check Valve Assembly
lst Check 2nd Checl: Relief Valve Air Inlet Check Va1ve
Iniaal Test DGClosed osed Ti;ht Opened at Opened at _nsid
Tight Leal:ed ❑ _�sid osid
Q� RP-_psid
�;� o Did not Opea o Leal:ed �
�P�
aad
Materials
Usod
Test After DC-Closed Closod Tight o Opened at Opeaod at _osid
Repair Tight � nsid _,_osid
RP sid
The above is catified to be true.
Firm Name ` � ' c.. Catifiad Tata 1�'��•��%��ft/'�'��
Firm A�,,•���L�dt i/.� '�lli�G�i�,,��"Cat Tes�ter No. Qi�6� Date� /��/
?���"
cauge # _�f.���/�t j �
Date last accuracy tested /L �%� �/�
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy