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2015_0121 , ,. ,-- _,. . , - - - -- - _ ;. . _ . ,. ,,, ., . _ - . ,, � � - ., -. . C�IECK ONE: IR.RIGATION DOMESTIC FIBELINE� BACI4'LOW PREVENTION ASSEMBLY TES'T AND MAINTENANCE REPORT NAN�OF PWS: CITY OF COPPELL PWS I.D.# � LOCATION OF SERVICE:.��� V`-'R S� G U Cr t� � 'Ibe bacl�tow preventioa assembly detailod below has bean cested and maintained as required by TNRCC ngulatioas aad is certified to be operating within acccptable parameters. TYPE OF ASSEMBLY � C �, Reduced Pressure Principle e Pressure Vacuimm Breaker �;7� Double Check Valve ❑ Amnosphere Vacuum Bnaker -�-- / �/ �� Manufacturer 7' �b� o Siu � f Model Number � '> �� Located At 1 i'oti � vO/cy f Serial Nimmber � �� (�� D U j' REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VAC'�NM BREAI�R Double Check Valve Assembly lst C3eck 2nd Cbeck Reiief Valvt Air Inlet Cheek Vaive � laidal Test DC-Closed;%. � Closed Ti�ht�°'�.�d' Opened at Opeaed at nsid Ti�t � Leaked ❑ nsid osid RP-�17sid I,�;� ❑ Did not Opea o L,eaked o RePairs aad Mat,erials Used Test A,ftar DC-Closed Closed Tight o Opene�at Opeaed at �sid Repair Tight � _�sid osid RP sid The above is ceitified to be true. � r �'""_ Fum Name�`�'V o ys ��/(' Certific�Testc _�rn��e ��s �v�_r�. . Firm Address r j��syn �D�J �S 7' Cat Taster No��P�0�3 6 i�a Date ��� / Y� 7X � GCJo� . ' Gauge � ��_.-, /�/��6 Date]ast accuracy tested r 4 ��- ��/ , White-Customer's Copy Yellow -City Copy Pink-Tester's Copy �