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2014_0827 C�iECK ONE: IRRIGATION DOMESTIC FIRELINE BACKFZ.OW PREVENTION ASSEMBLY TES?AND MAIIVTENANCE REPORT NAIv�OF PWS: CITY OF COPPELL PWS I.D. # � LOCATION OF SERVICE: �' ��-�? � '" �.'�.r- I="-��`� �t 1 tr��, , � � The bacl�low preveatioa assembly detailed below has bxa tested aad maintain� � nq�� by TNRCC regulations aad is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY C Reduced Pressure Principle � Pressure Vacui�Breaker �.+ Doublc Check Valve ❑ Atmosphere Vacuum Hnaker ,� Maaufact�er s-�-; : ,_� Siu ,. Modei Number �;_%_ Locatcd At �,,; ,'����, r t�_ ;:,f:. ,�` � .}'� ; Serial Nimmber ;� '-� �� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Doubie Check v alve Assembly lst Cherk 2nd Checl: Relief Valve Air Inlet Check Valve Inival Test DGClosed ; Closed Ti�t Opened at Opeaed at °rid Ti�t � Leal:ed o vsid usid d._� , : ���;, R.P- -�l_V Dsid � .�q �� p Did not Opea o Leal:ed � �P� and Materials Used Test After DC-Closed Closed Tight o Opeaed at Opmod at .�sid Repair Tight o �sid _�Dsid RP sid The above is cerdfied to be true. - _ � Firm Name ! �. - ;4 � Catifie�Testa � ;` '� � � � Firm Address 1 ��'c>`, `" �,-',y �� r �:�. Cert. T�ter Na r�`� ,Date = Gauge # 1 i 1 �F.�' � � � � i ; llate last accuracy tested i j( -` i!�-1 White- Customer's Copy Yellow - City Copy Pink-Tester's Copy _ _ _ . ___ _