2015_0513 C�IECK ONE:
IRRIGATION DOMESTIC � FIRELINE
BACI�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
N�ME oF PwS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: � Q � " 5 �o�� �
The bacl�low prevmtion assembly detaile� below has beea tested aad maintained as required by TNRCC
regularions aad is cerdfied to be operating within acceptable parameters.
TYPE OF ASSEMBLY
e Reduced Pressure Principle C Pressure Vacu�Breaker
'�. Double Check Valve o Amnosphere Vacuum Breaker
<<
Maaufact�er ��'i� + S Siu °�
Modei Ivt�ber C9 D 7 � � Located At S- �'-• �'o ie �- 2<z.
s«��N�b« � l 3 a�
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Double Check Valve Assembly
ist Check 2nd Checi: Relief Valve Air Inlet Check Valve
Initial Test DC-Closed Closed Tight `}� Opened at Opened at esid
Tight �. � 1� Leal:ed �`� o nsid _osid
RP-__psid
I,�;� o Did not Opea O Leal:ed o
�P�
and
Mataials
Used
Test ARer DC-Closed Closed Tight o Opeaed at Opeaed at __nsid
Repair Tight o Dsid __�osid
RP sid
The above is cerrified to be true.
�L � �e���1
Firm Name � ���e � �!�� CertiSod Teste �'
Firm Address ����o x 7� 7 �a'1`�`�- Cert. Tester Na f 3����`7� Date S-/�-/�
(�suge # U�+0`�! ?l �
Date last accuracy tested � �� ~��
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy
C�IECK ONE:
IRRIGATION DOMESTIC FIBELINE
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: � � � 5� �G y� �
The bacl�low preveation assembly detailod below has ban testod aad maintained as required bv TNRCC
regulations aad is certified to be operating withia acctptable paramcters.
TYPE OF ASSEMBLY
e Reduced Pressvre Priaciple � Pressure Vacui�Breaker
*.� Double Check Valve o Amnosphere Vacuum Breaker
� L/
Maaufacuaer �� � f Siu
Model Nimmber O � 7 � r Located At .5 . � �' o •L `� e �`
s«��N�ba � � y � 3
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Double Check v alve Assembly
lst Check 2nd Checi: Relief Valve Air Inlet Check Va1ve
Inival Test DGClosed Closed Tight � Opeaed at Opened at nsid
Tight �`� � Leal:ed atp o nsid __osid
RP-_�sid
Leal;ed ❑ Did not Opea o Leal:ed �
�P�
and
Materials
Used
Test After DC-Closed Closed Tight o Opeaed at Opeaed at �sid
Repair Tight o csid nsid
R.P sid
The above is catified to be true.
Firm Name �c�J d��� f=�/� � Certifiod Testa J�`i��i` � �`�/i�•� r
Firm Address ��./3 ° �� 7Y 7 �i�i�`X� Cert Testa No. I�l�aomv�o� D� S /3��
Gauge # !��O �//7�D
llate last accuracy tested 3`G`j �
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy
C�IECK ONE:
IRRIGATION� DOMESTIC FIRELINE
BACI�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: (,� � � 5� �°�/�/
The bacl�low prevmtion asscmbly detaile� below has beea tested aad maintained as required by TNRCC
regulazions and is certified to be operadng within acceptable parameters.
TYPE OF ASSEMBLY
C Raiuced Pressure Principle C Pressure Vacuimm Breaker
'�4. Double Chxk VaIvc 0 AIDnosphere Vacuum Breaker
�, a e�
Manufact�aer /-'` f��f' Siu
Modei N�ber � 5� Locaud At S' �` �'D�� t K
S«ial Nimmber l� C�1 �' s� �
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER
Double Check Valve Assembly
lst Check 2nd Checi: Relief valve Air Inlet Check Valve
Inival Test DGCIos�5 Closed Tight �r Opened at Opened at �sid
Ti�t dt' Leal:ed �' � o �sid osid
RP-_psid
I,�;� ❑ Did not Opea D L,eal►ed �
�P�
and
Materials
Used
Test After DC-Closed Closed Ti,rht a ppeaod at Opeaed at �sid
Repair Tighi o osid osid
RP sid
The above is certified to be true.
Firm Name ���i a� Y'/�t � Catifiod Testa �i�` � !//�`�`�
Firni Address �� - �3°X 7�' 7 Gv�r"��Cert Tester No. `�'���v�d`ZDate S��'/f
Gauge # �G�y! 7 Y�
llate last accuracy tested 3 �� ��S
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy
CIIECH 41�f8:
IRBIC�AT�OI�i DOMES'1'IC FIBELINB �
BACI�FLOW PREVENTI4N ASSEN�LY 1'FSI'AND MAIINTENANC�REPOR?
NA,M�OF PWS; ���'�'aF COPPELL
PWS I.D.#
LOCATTON OF SERVICE: � � / �- ��l !'�
The bac�8aw Pr�e+�aa �1y' de� b�ia�v Ims beea trsoed aod ma�d as n�d by TNRCC
re�alsc�s�md is c�to be oper�ag w�it�rm�a�ible p�s.
TYPE OF ASSE�LY
c� R�d pt�e principk e Pnss�ae Vac,u�B�iaer
:�� Taoobk Cl�oc�c V�Ive o Atmospl�ae Vacaum Bre�ar
� `�/ c�K 5 �'� Siu ��y
Modd Nnmb�er � C I.ocanod At s f �' G�ir�-L /7�
s�x�« �l `� � 3 � 3
REDU(�D PRFS,SURE PRIt�TTCIPLE ASSEMBLY PRESSURE VACUUM$�
no�c�v��b�
lst t7tacic 2�ad c�ec{c R�d�f r•atve Air Inlrc (�val�e
Ititial Tesc � l y � �Tl�c�o ���nsid �� �id
t �,
RP-�psid
� o Dud aoc 4pea o L,eaioeti a
��
aad
A+tatcials
Uaod
T+a�Affier DC-Clc�cd �T'�u o Opmed at Opcaad� �sid
� �;s� o �d ��
u
rhe ab�o�e is c�cd m bc av�.
F'iam I�t�ma�/'7� ��a�.v ��'l � � CertiSed T�cr /"�r ��� � ��i l��ti 1
FumAdd�+cp ��.�3o y ��l 7 ����Te�Na �I�pODo7��=/S
(�a�e # C�l�O �-/� 7� �
Date lest accuracy test� � �� _1�
Whfite-Customer's Copy Ye11ow -City Copy Pink-Tester's Copy