2014_1113 C�IECK ONE:
IR.RIGATION DOMESTIC FIRELINE �/
BAC�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: S�,D�LS �S/L/ ��� l Ln G4?/���
The bacl.-tlow preveation assembly derailed below has bxn iested aad maint�ed as required bv TNRCC
ra�ulations and is certi5ed to bc operating within acceptablc paramtters.
TYPE OF ASSEMBLY
c Reduced Pressurc Principlc e Pressure Vacu�Breaker
� Double Check Valve � Atmosphere Vacuum Breal:er
Manufacturer � TTr Siu ���
Modei Number �d`� Located At ��v��� /1'O6.�C
Serial Ivimmber �I�SI� �7
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Double Check Valve Assembly
lst Check 2nd Checl: Relief Valve :�ir Inlet Check Valve
Inival Test DGClosed Closed Ti�t Opened at Opeaed at nsid
Tidit Leal:ed o osid __osid
RP-��/ sid
/�/3—/�/ i,�;�a o 3 • O �a nac oP� o L,�:�a �
��
and
Materials
Used
Test After DGClosed Closed Tight o Opeaed at Opeaed at _�sid
Repair Tight ❑ Dsid osid
R.P sid
The above is catifiod to be true.
Firm Name ���cd��� i�.�'�a �i�C CertiSod Tester D�-ti� �S7r7��71� a`/a w
Firm Address %�" %/'� Cert Testa No.,/31��/�935� Date / �/
,L.�,�..�Q ao`�'�� T-Y 7SoS.2
Gauge # /Ov9o.��4
llate last accuracy tested '3�/7/y
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy
C�IECK ONE:
IRRIGATION DOMESTIC FIRELINE �
BACKF'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: ��t� y`/5i � �or.a �L.? C�����
T3e bacl�low preveation �sscmbly detailed below has beea tested and maintained as require� by TNRCC
regularions and is cercified to bc operating within acr.eptable paramtters.
TYPE OF ASSEMBLY
e Reduced Pressure Principle � Pmsurc Vacu�Br�calcer
.�� Double Chcck Valve � Amiospherc Vacuum Breal:er
Manufact�uer � �S Siu ���/
.
Modei Ivumber /7��-�� Locatcd At ��../T �. /t'aa.Y
s��N�ba S3S
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Doubie Check Valve Assembly
lst C3eci: 2nd Checl: Relief Valve Air Inlet Check Va1ve
Ininal Test DGCloscd losed Ti�t Opeaed at Opened at nsid
Ti�t Leal:cd ❑ nsid osid
��/ RP-�sid
///3 7 Leal:ed ❑ °Z� D I}id not Opea o Leal:ed �
�P�
and
Materials
Used
Test Aft,er DC-Closed Closed Tight o Opened at Opeaed at _osid
Repair Tight a �sid osid
R.P sid
The above is cerd6od to be true.
Firm Name /.�/c�a�`n .ST�.i�.. �`rr, Cectifiod Testet _ l0/!v �5�/'`i rl s Fz!l�
Firm Address��y��✓ Gt/ar��vJ-?�! Cat Tester No�Gb/•25�3�1 Date ///3�/Si
(�suge # _/Di0�o.���/
llate last accuracy tested 3—/7/y
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy