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2014_0819 C�IECK ONE: IRRIGATION DOMESTIC FIRELINE� 1� BACI�ZOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REpORT' � N�OF Pws: CITY OF COPPELL PWS I.D. # LOCATIOIv'OF SERVICE: l Jll 1✓or��oi�� Thc bacl�low prevcation asscmbly decailcd bclow has bxa 2Gsted and ma�n ain� � nq�� bv TNRCC rcgulaaons and is c�ertified to be operating withi�a acccptablc paramcters. TYPE OF ASSEMBLY C Reduccd Pressurc Principlc � Pressurc Vacuimm Brcaker � Doublc Chcck Valve � Aunosphere Vacuum Breal:eer � �� Manufacturer (' Siu Modcl Numbcr /�/l�� Locatcd At ,�v uT� �i�< <� �a�.0�"�" Serial Ni�ber �g'�`�i� � REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Check Valve Assembly lst C3ecl:�� pZ 2nd Checl:,�. Relief Valve Air Inl�t Check Valve Initial Test DGCloscd Closed Ti;ht Opened at Opened at osid Ti�t Lca}:ed ❑ osid osid ��r�q�/� RP-_psid �;� ❑ Did not Opea O Leal:e� � �P� and Materials Used Test ARer DGCloscd Closed Tieht � Opcacd at Ogcued at __nsid Repair Tight ❑ �sid osid RP sid The above is ccrtified to be truc. Firm Name ��tG ��1�`�S .��'►�� Certified Testa ,�/ v!�h Jevl n� C'7a/� 'i�' Fum AddrGss "7�'/ /D 9'`�' � Cat Taster No. �����-s�/ Date 8 �� / Gauge # ��/3�p3 0 Date last accuracy tested � 1�/� White - Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK ONE: IRRIGATION DOMESTIC t/J FIRELINE" BACI�ZrOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REpORT N�OF PwS: CITY OF COPPELL PWS I.D.# LOCATION OF SERVICE: /lII NO�h�vin�"f Thc bacl�low preveation asscmbly dctailed below has bcm i�sied and m�in a;n� � nq�� by TNRCC rcgulations and is ccrdficd to bc operaring within acccptablc paramctcrs. TYPE OF ASSEMBLY C Reduc�Pressurc Princinlc C Pressurc Vac�imm Brcaker �— Double Chcck Valvc ❑ Atmosphere Vacuum Brcaker Maaufacturcr �i(J�t I�7 S Siu v� � � Modei N�bcr DU 7/'j'!� Locatcd At S�Dt,I-��'1 S ��-C �'� T�� �lau- (� Serial Ni�bcr h �J�S� REDIJCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Doub[�Ch�c�c Valve Assembly lst Checl: �.C 2nd Checl:.�� Z Relief Valve Air Inlet Checic Vaive Inival Test GClos osed Ti�t Opeaai at Opened at vsid Lr,al;cd ❑ Dsid nsid g�ld�l,� RP-_psid Leal:od ❑ �� ., Did not Opea O Leai:e� � �� ' and `� Materials Used Test Aftcr DGCloscd Closcd Tight ❑ Opcncd at Opcncd at __osid Repair Tight ❑ nsid �sid I�P sid The above is catified to be tive. � Firm Name�AG S Cextified Tester y�b ��'1 v�✓�'' ��.�1 -r'i Firm Address �7s/ �a g� .ST Cert. Tes�c No. �1�oal.�3S l Date �l 9 Gauge # �(e/33d3o + Date last accuracy tested '7� �/j� White - Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK ONE: IRRIGATION �/ DOMESTIC FIRELINE BACKFLOW PREVENTION ASSEMBLY TEST AND MAIIVTENANCE REpORT N�OF PwS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE: ��-.��,� /V 0/'��U�o�� / The bacl�low prevmtion assembly detailod below has bxa ttsted and ma�nrain� � nq� bv TNRCC reEulaaons and is certifiod to bc operating within acccptablc paramttcrs. TYPE OF ASSEMBLY ❑ Rulucrd Pressure Princi�le ❑ Pressure Vacu�Breaker €Y Doublc Chcck Valvc � Atmospherc Vacuum Breaker Manufacturcr li(Ja�'f'S Siu .� � � Modcl N�bcr �o� I71 / 4�� Locaud At .��' Sic�C er� ��dq 6����f" Scrial N�bcr ,�''7�o 02 REDLJCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACULTM BREAI�R Double Check Valve Assembly lst Checl:�•a 2nd Checl;��a� ReIief Valve Air Inlet Check Valve Iaitial Test DGClosal Closed Ti�t Opened at Opened at nsid Ti�t Lea}:ed ❑ nsid osid ��/9�/� RP-_psid �;� ❑ Did not Opea O Leal:ed � �P� and Mataials Uscd Test After DC-Clascd Closcd Tight � Opencd at Opcued at __�sid Repair Tight ❑ �sid vsid RP sid The above is ccrtifial w bc truc. Firm Name az ��s�.s ��� C«tifiod Testa��'o G►h /�e 1'�r��1 ��r'G�ti Firm Addr�ess `7s/ /4 9'��• Ccrt. Testa No.t�'�O�S3S/ Date /`l / Gauge # �/(,033p 3 t7 Date last accuracy tested 7[�'�o7oJ� White- Customer's Copy Yellow - City Copy Pink-Tester's Copy C�iECK UNE: IRRIGATION DOMESTIC FIRELINE� � BACI�ZrOW PREVENTION ASSEMBLY TEST AND MAINZ'ENANCE REppRT NAME OF PwS: C�TY OF COPPELL PWS I.D. # LOCATIOIv'OF SERVICE: ,f��I , tl�h /�o�✓l� Thc bacl�low prcvmtion asscmbly detailcd bclow has b�ea t�sted and ma�nta�n� � nq�� bv TNRCC rcEuladons and is cerafied to bc operating withva ac�cptabic pazamctcrs. TYPE OF ASSEMBLY C Rcduc�i Pressurc Princi�lc ❑ Pressurc Vacu�Brcakcr � Doubls Chxk Valve � Atmospherc Vacuum Breal:er Manufacturer -e,r".5<-`� Sizc �!� `, rF�S'a( � Model Tii�bcr ��C Locaud At �n� ! e r� �a U 1� Serial Nimmbcr �� 3 �� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUiJM BREAI�R Doubl�Ch�rk Valve Assembly lst Checic� � 2nd Chec�:�.� Relief Valve Air Inlet Check Valve Inirial Test DC-Closcd Closcd Ti;ht Opened at Opened at osid Ti�t Leal:ul ❑ �sid �sid �`�(`��/`� �- �sid �;� ❑ Did not Open o Leal:ed ❑ �P� and Materials Used Test After DGClosed Closed Tight o Openod at Opmed at __�sid Repair Tight ❑ �sid osid RP sid The above is cctificd to be we. n Firm Name c � �, vi� , Cadficd Tcster �o�✓� �'1 n � Firm Address �7s/ /D�/� s � Ccrt. Testa No.��/.S�.�I Date �/I`�//S� Gauge # p�p l 3 303 v Date last accuracy tested ����/ White- Customer's Copy Yellow - City Copy Pink-Tester's Copy