2015_0515 C�IECK ONE:
IR.ItIGATION DOMESTIC FIRELINE
BACKFLOW PREYENTION ASSEMBLY TEST AND MAIIVTENANCE REPORT
NAME OF PwS: CITY OF COPPELL
PWS I.D.#
LOCATION OF SERVICE: ��✓_,1 ���� C� � ���
The bacl�low prevmtion assembly detailefl beloa has beea tested aad maintain� � nq�ed by TNRCC
regulauons and is catified to be operating withia acceptable parameters.
TYPE OF ASSEMBLY
C Reduced Pressure Principle C Pressur�e Vacuimm Breaker
�e� Double Check Valve o Atmosphere Vacuum Brealcer
Maaufact�aer ��� S;u � � �
Modei Ivumber �� Located At t �'�� �'� � ""iU
s«��x�� � �r�19Z�Z
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Double Check Valve Assembly
lst Check 2nd Checl: Relief Valve Air Inlet Checic Valve
Ininal Test DGClosed Closed Ti,,�ht � Opeaed at Opeaed at �sid
Ti Leal:ed ❑ _�sid _�sid
RP�sid � �
�� p Did not Open o L,eai:ed �
�P�
and
Materials
Usod
Test After DC-Closed Closed Tight o ppeae�at Opeaed at __nsid
Repair Tight 0 flsid �sid
R.p sid
The above is cerafied to be true.
Firm Name Gandara I tlon Ce�tifiod Testet � � �������
Richardson, Tx. 75082 C�Tester N����/� Z Date � s����
Firm Address -
(�auge � �-�//��/��-C� �j�Z <° �
Date last accuracy tested ��Z '�"C
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy