2015_0518 C�IECK ONE:
IRRIGATION /� DOMESTIC FIRELINE
BACI{F'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAN�OF PwS: CITY OF COPPELL
PWS I.D.#
LOCATTON OF SERVICE: ����(��/a �r�fl��
The bacl�low prevmtioa assembly detailed below has beea tested aad IDintain� � nq�� by TNRCC
reguladons and is certified to be operating withia accrptable parameters.
TYPE OF ASSEMBLY
c Reduc,ed Pressurc Principle ❑ Pressvre Vacuimm Breaker
�j Double Check Valve � t1.�nA�phere Vacuum Breaker
� �Sf rl
Maaufactsaer �]����`5 Siu �
Model Number 3 5� Located At !��" ���
Serial N�ber lT'77 3�9 � a`
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACULJM BREAI�R
Double Check v alve Assembly
ist C3�ck 2nd Checl: Relief Valve Air Inlet Check Valve
Inidal Test DGClosed a�2 Closed Ti�ht � Opened at Opened at osid
Ti�t � Leal:ed o Dsid osid
RP-_psid
I,�;� p a�$ Did not Opea O Leal:ed J
�P�
and
Mate:ials
Used
Test Afttt DC•Closed Closed Tight o Opeaed at Opeaed at __flsid
Repair Tight o osid __nsid
RP sid
The above is certifiod to be true.
Firm Name '91 Aoeuraev Backttow Catified Testa��6)'1 �f�1'1��1�/'1
�o s.�oo c��� -1� -►5
Firm Address Fr�scn�TX 75 3��_ Cat Testv No. ��f Date
972-699-�156 '
Gauge # (���a�2Qg
llate last accuracy tested � �/�
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy
,