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2015_1008 C�iBCK ONE: IRRIGATION_� DOMESTIC FIRELINE BACKFLOW PREVENTION ASSEMBLY TEST AND MAINI'ENANCE REPORT NAME OF PWS: CITY O�' COPPELL PWS I.D. # ....r..-- • r�, � LOCATION OF SERVICE: �..:� � C�(-'�' �-�- ��L"� C' , The bacl�low prevmtion assembly detailed below has beea trsted aad maintained as required by TNRCC regulations aad is cerdfied to be operating within ac�eptable parameters. TYPE OF ASSEMBLY C Reduced Pressure Principle e Pressure Vacui�Breaker � Double Check Valvc o Atmosphere Vacuum Bnaker _ , �.� ___ , � Maaufacnaer '' �'�' Siu - f�� A ' � .+� � ��}�,"� -J� �! � . Model Number .:�' -� Located At r , ;� � � , _. --, �-. � Scrial Nimmber '�1� , � P , � ' REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Check Va1ve Assembly lst Check �nd Checl: Relief Valve Air Inlet Check Valve ', Ininal Test DGClosed Closed Ti,Aht Opened at Openai at nsid Ti�t ' . `!� Leaked �`�°� a vsid �usid RP-__psid I,�;� a Did not Opea o Leal:ed � �P� aad Mataials Used I Test,ARer DGClosed Closod Tight o Opened at Opeaed at _nsid Repair Tight a _�sid __nsid RP sid The abova is cerrified to be true. _.� r , / � � ^ , .,:'l1�,1 ..,-�� ' � � � � Firm Name �� r � � �' ='r'� !� Ce�ctified Testa �` -�� , <-r_ Fi�m pddress �,��,�_ ��'� �� -e '�-�� Cat Testa Na �'�`��'�' � � � �!�a[e C�� ,r:_ ; .. _ ._. �,. � � f } `� T � ��'` . Ga e # ,-J;� / y p,`,; llate ]ast accuracy tested �� '� '� '"�,,,.- ; ,`- White- Customer's Copy Yellow - City Copy Pink-Tester's Copy �