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2015_0113 C�IECK ONE: IRRIGATION DOMESTIC FIRELINE ✓ BACI�LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPOR? rr.�N�oF PwS: CITY OF COPPELL PWS I.D. # .S""Ta�/�S LOCATTON OF SERVICE:2 0� o i ��/�l/,T, 6 �` . Tbe bacl�low prevmtion assembly detailed below has beea tested and maintained as required by TNRCC regulations aad is cectified to be operating withia acceptable parame�ters. TYPE OF ASSEMBLY C Reduced Pressure Principle � Pressure Vacu�Breaker � Double Chxk Valvc o Atmosphere Vacuum Brealer /- / 3`� -, Maaufact�aer !/� a� s Siu Model Ivumbcr o 0 7 dv�. � Locatad At /C�r���.� � �� f 0. ss Seriai N�ber S''f � 5"' 6 REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER Double Check v alve Assembly lst Check Znd Checi: Relief Valve Air ldet Checic Valve Inival Test DC•Closed losed Tight Opened at Opened at nsid PQ fs Ti�i��c f Leal:ed 0 �sid _�sid �-_ps�d � , Leai;ed o Dia noc Opea o I,eal►ed � �P� and Matec�ials Usod Test Af�r DC-Closed Closed Tight O Optaed at Opeaod at _�sid Rtpair Tight ❑ �sid _osid RP sid The above is cerufied to be we 4��s�..�.-,� ���5 Fitm Name l`;r`� �wa��-�'r�o�-► Certifiod Testet �e .y �e,'"'`��`•.� Z 3�fS" �✓- 1/1/��",�ir- �Po o/Z!S D� /—l 3— Zol.f' Firm Addrcss �-�-L- Cert.Testc No. �� `n�l�/ZS�o S'y Gg� � ZS $0�6 llate last accuracy tested �Z— � !� White - Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK ONE: IRRIGATION DOMESTIC FIRELINE � BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT N.�OF Pws: CITY OF COPPELL PWS I.D. # 57-a,-P/�s LOCATION OF SERVICE:Z a � No.��pb;.�.t� �r�D�//. ,TX, 76 0l j . The bacl�low prevmtion asscmbly detaile� below has beea tested aad maiatained as required by TNRCC re_euladons aad is cerdfied to be operating within acceptable parameters. TYPE OF ASSEMHLY e Reduced Pressure Principle ❑ Pressure Vacuimi Breaker �� Double Chxk VaIvc o Atmosphere Vacuum Breaker Maaufactsaer (�� a�s Siu g'ii Model Ivi�ber 7 Z� � C ��" Located At ���"�!J-'^-e— s«��r+�ba /° � s 7S REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Check Valve Assembly lst Check 2ad Cbec1: Relief Valve Air Inlet Checic Valve Ininal Test DGClosed Closed Ti,pht o Opened at Opeaed at _osid �r�� Tight ❑ Leal:ed osid _osid /� RP-_psid �;� Did aot Opea o Leal:ed ❑ �P� and Mataials Usod Test After DC-Closed Closed Tight a Opeaed at Opeaed at _.osid Rapait Tight o nsid _,vsid RP sid The above is certified to be true.s,��S Fum Name ����'�''�'� Certifiod Testa ��o J �r�-��`•-•� , ct!-r,ol� �L / — 3— Z ..S!' Firm Address=�'�'�•�r�--fT-Z Cat Tesmr No. l� °°�2/g�Dace ! �l '7 S�s-z c�suge # � S'g� S`6 Date last accuracy tested � Z � � Z D!� White- Customer's Copy Yellow - City Copy Pink-Tester's Copy � +�tlli(.K U�I:: [l��tIC:�1TION llOM�"TTC FIREI,I2�E �� BAC�.OW FREYENTION ASSE�tBL�'T£.ST A,�'D�iA�"'TE.°'�A.�tiC�RE�'ORT NAA�OF P'W5: C`7T3'C�F C'C)PI'ELL ��LrS I.D, � Si"�-�'/�s LOCATION OF SER'��iCE:� � f �u'�� a:�.�-t o,�,_�f���r �"�QP � �hr bacJ�Io�� prc+�casioa �cmbh• c�esai}ai be?oa� h.�s b� t�+`.d a^a3 �- :^"' a:s r�....� tr� 3"'ti+:�C� ncgul,a�dozu�ad is cc�iia�d ct�t�t�p�csa��•��sthin s�ta�Ic g��s. "�?�'C3�:q.SSt"_bi�L's C Rafuc�l Fr�ss�srz Pzi�zt�te .. :�s�,.lr:�'s:�.���:. T�''`" D�oublc Ch�:V alr� -- �+���=�a,^^,.,�Bsc.st� [ ��P z- (/`'-� ,�,""T�" .S� "' �*"rr l � �!��T111�1Ci�II'�' . �L:� �. �D Z 1�4cadcl S�umbcs ,� ,� `� �` C �.''� Lc�cai�:�; �"'- `�'. �;„� Scsial Ntm�ba f o cs S'7�' 1tEbUC€D PRFSSL�tE PRii�'CIPLE.�E�LBL`t` � P�SL'�tE�;�►C'U'L�:►i�RL.�R. Aa!n3�le Cbrc3c��Ive 1+►ssess�bl� lst CLttck �nd C"bttf� Rciitf'�'ah-t �,ir�e3 C�rt3cZ'ahe Ini�tial Tcst I)C-Ctosad Cies�Ti�z � ��t t�s�s: �s:d �� Ti�tt � C.r.sl.� �siti c�sW RF• ti�d ' i.ea�xd �':���:�°';^r� : �.:.s:R:� �� . /J R �,•,.� � � Q,r�.6Y`sd' G�G�C+1�� ��eGK 7b�/ �� L'� T�tt Al�rs DC-C� �ad T'rg�s o C?�m�d st C?��!at ���� �7 � RP��, q 2,� _,_,--�----�zic� r��i 'i`ha�+ava�i�aert�d�b�trnc.��S F'mmNams r�� ha��'�•^� ��erti�cdTe�es !�F �. ,� ����;`,4� �.-3 ex,rrtrbv��h�.i�-- � / —'� = e't'..5� F�m�di��t���„�����"`�` Ceart.T�et 3�. '�����1�"t� ' �.' 7 S"�.s'-� ��,,� � �, 3"`�`o$"'-�, v.te�t�cy te�ted ��r � � � �f� ►Mlrtt�-t�ui�oa�is Capiy',. Yeli�r-Cit��€�op�r Pu�e-Te�t�r's C�Py , •_ .. �� : . . , u , : . _ . , _ . . ., ,; . _ � � �canned [�y CamScanner