2014_0826 C�IECK ONE:
IRRIGATION V DOMESTIC FIRELINE
BACT�LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REpORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
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LOCATION OF SERVICE:_�"�� �� I'�'`1�'J V� ►�1� C�` C�A l��' I I ���( ��-���
The bacl�low prevmtion asscmbly detaile� below has beea tested aad n,a;�t�ed as requi�d b�, 'I'I�1RCC
reguladons aad is certified to be operating within acceptablc parameters.
TYPE OF ASSEMBLY
�e Reduced Pnssvre Principle e Pressurc Vacu�Brealcer
Double Chxk Valve o Atmosphere Vacuum Breaker
Maaufact�aer ��`K�V� Siu `�'l°� i�
Model N�ber �J��1 Located At ��.�� ' :�.7'��.����4�'�
S«ial N�ber � �J�U ���^ ►'�'1�-��,�`
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Double Check Valve Assembly
lst Check z o Qj 2nd Cbecl:�j,� �ef Valve Air Inlet Checic Valve
Initial Test DGClosed Clos�d Ti,�ht Opeaed at Opened at �id
Tight Leal:ed o �sid __esid
�� �1 RP-_psid
I�—I Leal:ed ❑ Did not Opea o L,eal:ed o
�P�
�� I� �I�L �; �� Lf
U�
Test ARer DC•Closed Closod Tight o Opeaod at Opeaed at nsid
_�
Repair Tight ❑ _nsid _osid
RP sid
The above is certified to be we.
h— � ',/
Fi:m Name �f G �° � �'��Certified Testa - �
A „ � �'l�l d �1�1_� �'",�
�'IIG �'4, L. tt��`�a��c . - �'�7" �� '
Firm Address v �� r1 �C � l "� CeR Testc No.����� Date ����I �}�
(�auge # ,��;% �''���i��
llate last accuracy tested �' '� � �
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy