2014_0818 C�IECK �NE:
IRRIGATION �, DOMESTIC FIRELINE
BACI�'I.OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
[�. __--
LOCATIOIv'OF SERVICE: % �,I /y�,�, �
The bacl�low prevmtion assembly detailed below has baa tested aad n+�ta�*+cd as required by TNRCC
reguladons aad is certified to be opera�ng within acceptable parametcrs.
TYPE OF ASSEMBLY
e Raiuced Pressurc Principle C Pressvre Vacu�Breaker ; '
�--'" Double Check Valve ❑ Atmosphere Vacuum Breal:er '
Maaufactiaer ��' �rv Siu � ��
� ��
Model N�ber �'Jt'f Located At � ; � - � �, �
Scrial Ni�ber t�� � "`'��l�
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACWM BREAKER
Doubie Chetk v alvt Assembly
lst Check 2ad Checl: Relief Valve Air Inlet Check Valve
Inidal Test DC-Closed Clo��d Ti;hi� Opened at Opened at osid
Tight eal:ed � ❑ nsid osid
RP-�sid
I,�;� ❑ Did not Opea o Leai:ed �
RePairs
and
Mataials
Usod
Test After DGClosed Closed Tight o Opeaed at Opmed at �sid
Repair Tight � csid __osid
RP sid
The above is catified to be true.
-- �1 �` • - ��-__. ----.
Firm Name �.� ��.`,r�� �i,�; �; CeraSiod Testa �'=-__
' �� /' � �; �"/ �.
Firm Address u y t.�-- /��. , �'`i1.-,..., Cert. Tester No. 1 Date �� �
� �
Gauge #�1'�,�fil�/,�y
llate last accuracy tested ��? S��y
---a
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy
i