2014_1105 C�IECK ONE:
IR.RIGATION DOMESTIC FIRELINE �
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAN�OF PwS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: 0�00 �DRTH P 01 N T
The bacl�]ow preveation assembly decailod below has beea tested aad maiatained as required bv TNRCC
re_¢uladons aad is certified to be operating withia acceptable paramtters.
TYPE OF ASSEMBLY
C� Reduced Pressure Principle � Pressure Vacu�Breaker
�� Double Check Valve o Amiosphere Vacuum Breal:er
Maaufactsaer I'�L3 C d Siu 8 ��
Model Number �S 6 Located At �N VA U L T- ,Y D R?N 1.�1�ST p F
Scrial Ni�ber
� 45a81 "�06 � 8 � � d9 q� fhe STRE�7.
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Doubie Check Valv�Assembly
lst Check �nd Checi: Relief Valve Air Inlet Check Valve
Ininal Test DC-Closed ��b Closed Ti,Qht � Opened at Opened at osid
Ti�i ❑ Leal:ed ❑ Dsid __osid
RP-_psid a, �
�� ❑ Did not Open o Leal;ed �
�P�
aad
Mataials
Usod
Test ARet DC•Closcd Closed Tight o ppencd at Opea�at _�sid
Repair Tight ❑ nsid __osid
RP sid
The above is certified to be true.
Fi�m Name i�o E t T E R I�l 1?E PR o T , Cerifiod Tesca �A R`I G I o u�R
Firm Address I D 3 5 ( p L Y P''1 P.I C P R Cnt Tester No? �I) 5 7 a Date I^ ' I
Gauge # B y 11 / 9 5�
llate last accuracy tested b'3� �e/
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy
C�iECK ONE:
IRRIGATION DOMESTIC FIftELINE �
BACI�LOW PREYENTION ASSEMBLY TES'T AND MAINTENANCE REPORT
rr.�OF Pws: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: �CJ C /�f o i�r N P o r nl T E
The bacl�low prevmtion assembly detailed below has beea tested aad maintained as required by TNRCC
regulauons and is cudfied to be operating withia acceptable paramcters.
TYPE OF ASSEMBLY
e/ Reduced Pressure Principle ❑ Pressurc Vacuimm Breaker
5' Double Chxk Valve o Atmosphere Vacuum Breal:er
Maaufactsaer ,�e L3 _O Siu 3 f� �1
,�,� 1�a u c.T - N, I�l, n�
Model Number g�)� y � Located At �'d G# �T R E�r
scrial N�ber �s Ru sr�D (7uT �
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Double Check Valv�Assembly
lst Check ?nd C3ecl: Relief Valve Air Inlet Check Va1ve
Inidal Test D -Closed a� I Closed Ti;ht Opcaed at Opeaed at osid
TiQht ❑ Leal:ed ❑ _�vsid osid
R.P-_psid
�;� ❑ � > �C Did not Opea o I,eal�ed �
�P�
and
Materials
Used
Test After DC-Closed Closed Tight o Opeaed at Opmed at _�sid
Repair Tight o �sid _nsid
RP sid
The above is cerafied to be true.
'/ � /
Firm Name l�0�%l ER 1�-L l�E Cerdfied Teste �R y �y l D v�/Z
L3f'
Firm pddress l b 3 5 I UL!� � C p R Cert. Tester No. DO I I 5 7 a Date "l I 5- �y
����As x 7 sa a�
Gauge # 1�y 1119 5(�
llate last accuracy tested �p ' 3 �1 �
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy