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2015_0623 . , L .. ,, y ; _' .... . y .. �... _ '� . .. . . � ^�'� �'k � �� . . ' � , C�IBCK ONB: , A�, IRRIGATION� DOMESTiC ' FIRBLINB� � BAC�LOW PREVENTION A�SSTIV��,Y TES?AND MAII�ITENANCE REPOA3' NA1ME OF PWS: CITY OF COPPELL ,.� pws I.n.# ` ; LOCATION OF SERVICE: � �� '� '� � � � The baci�low preveation assembly detailed below has beeq.��°lested aad maintaincd as nquirod by TNRCG � re ons and is c,ettified to be ' within � ; � �8 �P�k pa�ameaers. TYPE OF ASSEMBLY ; G Redc�ccd Pressvre Aria«ple c Pressure Vacv�Breaker � , ,,,�'""'� Double Che�k Valve o Am�osphere Vacuum Bnaker , Maaufactsaer �"� �`��,� Siu � � ��' ��'�� . �� ` � ��_ Model N�ber �''� Lecated At � . �'�� r�+'� ,Serial Nimmber ;�,� � �� , . � , _.;' ` REDUCED PRESSURE PRINC'IPLE ASSEMBLY PRESSURE VACUUM BR�AI�ER .; Doabte Check V alve Assembly ; 1st Check 2ad Check Rdief�alve Air Inlet ` Check Vah►e -� Inirial Test DC-Closed Closed Tight �Opeaed az Opeaed at :,_._.M. ':asid � � � _„—� , Ti� .�'J` Leal:od o _nsid ��e.�d , R.P-.�psid ?',� �.� , Leak«i o Did not Opea e i,eahed o � ; i RePairs �. aad I Mataials Usod i rac� ;pc-ci�a ci�a r;�c o o�� o�� ua i �� _ Tls� o ._,��a ��a .RP •d Tbe above is cerdfied to be true. _ � i ' Firm Name Cert�fied Testc __ ��.'�.''/'� M�t� (,,.� a�''�-1+�� 3�1 G�I7� � � �_,,,. � � � �i Firm Addr�as Ittcharafso�,� �soaa Cat Testa No. �� - �� Date "' �„�"�°� ' Gauge � _�"�'�,�'i�� .� �� (�r � : Date last accuracy tested +��",��1'";� , �� ? 1�,.f��, : White- Customer's Copy Yellow -CitY �PY Pink-Tester's ' ; CoP� :�