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2015_0427 C�IECK UNE: IR.RIGATION DOMESTIC FIRELINE � BACI�'LOW PREYENTION ASSEMBLY TEST AND MAINTENANCE REPORT :; NAN�OF PWS: CITY OF COPPELL � PWS I.D. # LOCATION OF SERVICE: `�/1'S �'�.,,�.�, �,'�� �'�,�,�rl� ��� �� �,-f"/ The bacl�low prevmtion assembly detailed below has beea tested aad maint�nC� as nquired by TNRCC regulations aad is ceroified to be operating within acceptable paramtters. TYPE OF ASSEMBLY � Reduced Pressvre Principle C Pressure Vacuimm Breaker - Doubk�hxk Valve . . , _. o , Am�osphe�ee Vacuum Breal:er .. _ � . . , . . , ..4 _ _. , � Maaufact�uer Lt/� .3 Siu .��y" Model Iv�ber G°l:7 �'I/ Locatod At _�tv �= c��.a ri' �'.r`�6`�i�`�/.G'�'!'� serial N�ber �'��G � . REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACULTM BREAI�R Double Check Valve Assembly lst Check 2nd Checl: Relief Valve Air Inlet Check Valve Initial Test DGClosed Closed Tight 0 Opeaed at Opeaed at _nsid c�����— Tight Leal:ed �sid _nsid RP-��psid : L,eal;cd ❑ � Did aot Opea o Leal:ed � RePairs and Materials Usod : . �_ . : . _ , � _ , , . Test After DC-Closed Closed Tight o Opmed at Opeaed at _�sid Repair Tight o :osid __osid RP sid The above is ce�tified to be we. Firm Name ���iv fi"��-�'�v,�',r� Certifiod Testa �.���r-�,.�?��.--�-�� Firm Address � � ! Cert Teste No.�1''t,+r��.3v5�s Date `'�-�'',�� � �.c.r T`.� ,�_.s".�7 � b Gauge # /!�/G/�-�'-� � � Date ]ast accuracy tested �/�:'f��� White - Customer's Copy Yellow - City Copy Pink-Tester's Copy . _ _ __ _ _ C�iECK ONE: IR.RIGATION DOMESTIC FIftELINE BAC�ZOW PREVENTION AS5EMBLY TEST AND MAINTENANCE REPORT � CI�Y OF COPPELL . NAM£OF PWS: <, PWS I.D.# LOCATION OF SERVICE: 11�..� �'.��i''��� fi%r - ��1�r'��� ,,,�. 6.��"1 The bacictlow prevmtion assembly detailod below has beea tasted and maintained as required bv TNRCC regulauons and is cerdfied to be operating withia acceptable paramcters. TYPE OF ASSEMBLY C Reduced Pressure Principle ❑ Pressure Vacui�Breaker . . � �Doubl�Che�cic VaIve .; .> , o,�„R*�1�mosphe�e Vacuum Breaker � Maaufacnaer %�f}7�7�� Siu /`� " Modei Number �!r"� Locaud At .jW ra�.�ri o����+'''�;v !/..�vl� ScrialN�ber ,�%r� /.l�'�� l�l��r { REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R ,. Doub(e Check Valve Assembly 1st Check 2nd Checl: Relief Valve Air Inlet Check Valve Ininal Test DGClosed losed Si;ht o Opened at Opened at �osid . �a�J� R�`- ��sid L�� �nsid __osid Leal;ed m � Did not Opm o Leal►ed o RePairs aad Materials Use,d il , Y ; � s.. _„ _ . _; . , Test Aftet DC-Closed Closed Tight o ppened at Opeaod at _�sid Repair Tight o osid �,nsid RP sid The above is catified to be true. Firm Name �1 r�rv �:'.��1�lo��C��.r� Certifiod Testa.�•�;rs,���r�.� , E Firm Address /r�c.�/E���v lr.�.l Cert.Testc No. ��''�/�s�/i Date�.?1-./r ' ? � � ,t1.AfL�.� �' �.��.2 9' � r , ���� GBitg@ ? //G'/�%/��iS . � � . . - � i: Date last accuracy tested /`f;/� /5�` White - Customer's Copy Yellow - City Copy Pink-Tester's Copy