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2015_0112 C�IECK ONE: LRRIGA�'ION DOMESTIC FIRELINfi ✓� BACI{FZ�O�V PRE�'ENPION ASSEMBLY TEST AND MAINTENANCE REPORT NAI�OF PWS: CITY OF COPPELL Pws I.D. # ��,,n �--S�zr�i1 �-3 LOCATiON OF SERVICE: �3 3 �'i �.(_/(/�(�.t3CLu �G� CO Y�.Q�- 7�� ( The bacl,�flow preveatioa �ssembly detailed below has beca tested aad ma�n a�n� � � bv TNRCC reQulanons and is catified to be operating withia acceptable paramcters. TYPE OF ASSEMBLY C Reauced PrCSsurc?nIIcipiC C PreSSurC V3Cut�Bre3kei �, �ubie Lhcck V alve � Atmosphere Vacuum Breal:er � ';�l -� Siu ,, Manufact�er ° Model Iv t�bes 1�,j1C.� Located At 1 n �/4�v/� G�.S�r/c v�,(3/�.r,� s«��N,��a 1 � 3a�.� �w� � ;��� �e��� � ItEDUCED �RESSL'RE PRINCIPLE ASSEMBLY PRESSURE VACUtJM BREAI�R p Doa�ble Ch�ck d alve Assembiy lst Check '�ad Checic Relief Valve Air Inlet Check Valve Iaidal Tes2 � DC-Closea ; Closed Tf;ht Q� � Opeaed at Opeaed at nsid �� � Tight � � Lcal:ed ❑ � �sid osid � F�P-�sid � f.g � j p�;� �, Did not Opea O Leal;ed � �� � ' � and � ; � MateriaLs ; Used ' � Tcst Aftst + DC-Closea � �losed Tight � Opmed at Opmed ai nsid r Repair TP�ht ❑ � �sid nsid � RP sid ' The above is cermfied to be�ie. Firm Name ��rc�ewut.t�i'c, feS�t�.^� Certified Test�er �r�v i� i'/lC��.,-t `�� Firm Address ���• x?°iS�fSS t=1�";ix��f7�1 Cat Tes�er No. ' ��� Date �/ f�'�� Gauge �k �d �[�`IU � llate last accuracy �ested � �.I White - �ustomer's �opy I�eliow - City Copy Pink-Tester's Copy C�IECK ONE: IRRIGATION DOMESTIC FIRELINE V � BACT{FT.OW PREVEN'TION ASSEMBLY TES?AND MAINTENANCE REPORT NAME OF PWS: ���'Y��' �OPPELL PWS I.D. # �p ol�Z� �J� LOCATION OF SERVF�E: ' �7 The baci�low przvm�aa assembty desailed below has beea tested and maintaiaed as roquired by TNRCC re_�ons aad is cccrd�e�s,�be ot�esating within acceptable parameters. :'YPE OF ASSEMHLY _ Reduced Pressure�:incipte � Pressure Vacu�Br�aker G� Dou�le Chxlc V alve � Atmosphce Vacuum Breakec Manufaca:rcr ��a�� Siu ��`f Model Nimaber �.^�?✓✓t( I,.ocated At .Lr, �o��l f� �✓S•r�e v���•p, Scrial N�ber ���i � ; �tEDUC'Ei3 PRESSL'ItE PRINCIPLE ASSEMBLY PRESSURE V:�CULJM BREAI�R r pouble�eck V�Iwe Ass�mbly " lst C3ecic i 2nd Checl: Relief Valve Air Inlet Check Valve Ini�al i est � £�C-Cioscd , x C�osed Ti;ht �" Opeaed as Opeaed at nsid �L.� � '�'p�$ �i t L,CB►sCt�a � � D514� DSld �/ � �-�Sid ? �-CP i � �;� � � Did not Opea o Leal:ed � R �P� � s and i ; � Matcials i � Used � � Test A#�r � DC-Closed � �Iosed Tight � Opeaed at Opeaed at osid Rtpair ` Tighi e � flsid nsid R.P sid � The above as certified 20�e�ue. Firm Naaie f-fi'�•z��,+^��� !uh� Ce�tifi�d Testa �b��,p��c`. �('�--�� Firm Address 1?C�Lr�� ���" �r�7�117�Cat Testc No. ���UI S3�SDate �'��-/� (�auge # t'�[� 01 U�'Z�o - llate lsst accuracy '�este� �( "�' White - ;:ustogneras �op�s ��ow - City Copy Pink-Tester's Copy