2015_0430 C�IECK ONE:
IRRIGATION DOMESTIC FIRELINS
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: �'�1� 1 ► !C�`�U L�( I��(Jl1 OC3�1 �.
The bacl�low prevtatioa assembly detailed below has beea tested aad mainYain� � nq�� bv 'I'NRCC
re_guladons aad is certified to be operadng within acr.eptable parameters.
TYPE OF ASSEMBLY
e Reduced Pressure Principle e Pressurc Vacu�Breaker
� Double Chxk Valve o Amiosphcre Vacuum BreaL-er
I „
Maaufact�aer ` l�C�I 1�)� Siu f
Model Number �J� Locatcd At I� � � �,���.4�
Serial Nimmba —l
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER
Double Check Valve Assembly
lst Check 'nd Chec.l: Relief Valve Air Inlet Check Va1ve
Inival Test DC-Closed I.� Closed Ti,,Qht Opeaed at Opeaed at esid
Ti�i q� Leal:ed 2• � o �sid __nsid
R.P-_psid
�;� ❑ Did aot Opea o Leal:ed �
�P�
aad
Mataials
Used
Test Aftet DC-Closed Closed Tight o Opeaed at Opeaod at _�sid
Repair Tight � esid osid
R.P sid
The above is certified to be true.
Firm Name�I C�/l I"� ��C��� a w Certified Testc �. , �-
�I U� 5 C.e(�Gr �-};i 1 2c�
Firm Address Cec�r�!c l�`rX 151ou Cert. Testc No. ��-�1-3 Date � �
Gauge # (J"�v�O��
llate last accuracy tested �` � t'f�
White - Customer's Copy Yellow - City Copy Pink-Tester's Copy