2015_0812 C�IECK ONE:
IRRIGATION DOMESTIC FIRELINE
BACI�ZOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAIviE OF PWS: CITY OF COPPELL
PWS I.D. # `��u_ �p�'1-�C�1�'
LOCATIOIv'OF SERVICE: ���71�1fY1 Cpn�,rr� �(.U� �JbI�'�l
The bacl�low prevmdon asscmbly detailed bclow has beea tested aad IIIrl�ntain� � nq� bv TNRCC
regulanons and is certified to be opera�ng within acceptable parameters.
TYPE OF ASSEMBLY
C Reduced Pressure Principle c Pressure Vaca�Breaker
e� Do�b1�e�C�k Valve � Am�osphere Vacuum Breaker
Manufact�er l�"�'S Siu (��►
Model Iv�ber � �TC�'1 Locatcd At Tn �.b.�fa- � f--r+k+�� d-;
s«��N,mmba � �t�ac,g
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACULTM BREAI�R
Double Cherk v alve Assembly
lst Check 2nd Checi: Relief Valv� Air Inlet Check Valve
Initial Test DGClosed Closed Ti�t Opened at Opened at esid
Tisht Lcal:cd o nsid osid
R.P-�sid
L,�;� p ��� Did not Opea o Leal:ed �
�P�
and
Materials
Used
Test Aft�er DGClosed Closed Tight O Opened at Opm�at _�sid
Repair Tighi ❑ �sid nsid
RP sid
The above is cerrified to be true.
Firm Name l�k�i rc�-C�^r��c�h��5�1�Certifiod T
Firm Address PU���'� Cert. Tester No.l���53 f��Date 3—_
�w�-VJb�I'cc.-"�e yc 1 b 1'l�
(�suge # ��=\Y i rS ���S a l�U7 05-1�o
llate last accuracy tested � 2-� �u
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy
C�IECK ONE:
IRRIGATION DOMESTIC FIRELINE
BACI�'I�OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. # V�.t,S�lir��,P,v�P�r
LOCATION OF SERVICE:�� 'RsArn C�,r1-4P�-- 1��U OI `1 SD ��
The bacl�low prcvmtion asscmbly detailod below has beea tesied aad ma�n ain� � nq�� bv 'I'NRCC
regulations and is cectified to bc operating withia acceptable parameters.
TYPE OF ASSEMBLY
C Reduced Pressure Principle ❑ Pressura Vacu�Breaker
� Double Chxk Valve p Amoosphere Vacuum Breal:er
Maaufacaaer �Al� Size 3�`f
Model Number O�?►�l�� Located At -1 n �o.0�-�' o' Fr�^rc..�.
Scrial N�ber o�QI(� g�.
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACU[JM BREAI�R
Double Check Valve Assembiy
lst Check 2nd Checl: Relief Valve Air Inlet Check Valve
Inirial Test DGClosed Closed Ti;ht o Opeaed at Opeaai at osid
TiQht ❑ Lcal:ed ❑ �sid nsid
RP-_,psid
�;� ❑ Did not Opea ❑ Leal:ed �
�� /l/ccr� � j��``Q� �s 2,��/ � ��°-�s
aad S C/'o c�.�h .evvt' �v«.o/�
Mataials �lso �.�°'ss 4�-�- /
USCd C�ca�t o aJ+-
Test Af�er DGClosed Closed Tight o Opened at Opeae�at __nsid
Repair Tight o nsid nsid
RP sid
The above is ccrrified to be true.
Firm Name���t2,4-�rr�Ps�c��t�Certifiied Testa �'i�"
Firm Address �Pb�6x'10. $ Cert. Testa No.'(�j.'��Q����Date 3"��'I S
�+vS�Te.�-��Rq
Gauge # Ul�11�l�►�S�5 b�C�d'� ^7!�
llate last accuracy tested i2-?�• ��
White - Customer's Copy Yellow - City Copy Pink-Tester's Copy