2014_0826 C�iECK ONE:
IRRIGATION_S� DOMESTIC FIRELINB
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENAI�ICE REppRT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
e I._L, �.� l�
LOCATTON OF SERVICE: �I'4 ��I'1�'�[:JVr� �f; �(U� T ����r
The bacldlow preveation assembly detailod below has beea tested aad maintained as required b�, 'I'NRCC
regulations and is cerdfied to be operadng within acceptable parameters.
TYPE OF ASSEMHLY
C Reduced Pressure Priaciple e Pressvre Vacui�Breaker
�! Double Check Valve o Atmosphere Vacuum Breaker
Maaufactiaer VU ��K-1 VU� Siu �1� �i
Modei Number �� Locaud At �J1C� :� Q.�j��C� � TV���'1 f'YI��'4`'
Serial Nimmber �`�C��LJ �' L
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACULIM BREAI�R
Doubie Check v alve Assembly
lst Check�e �j ?nd Checl:�., ReIief Valve Air Inlet C3eck Vaive
Inival Test DC-Closed Closed Tight Opened at Opeaed at _osid
I Ti�t Leal:ed o _nsid __esid
�� �G, R.P-__psid �
Leal:ed ❑ Did not Opm o I,eal:ed o
�P�
� IV� �U►�1C I�i�i���i
Mataials
Usod
Test Afttr DC-Closed Closed Tight o Opeaed at Opeaod at esid
�
Repair Tight o �nsid _osid
RP sid
The above is catified to be true.
Firm Name � `��� "� � �
Catifiod Testa �L��� ��-�-��-�
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Firm Address Cert. Tester No. �P�h_����1�Date����
ca� � �1�� �.2�t I
llate last accuracy tested �1 � ��
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy