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2015_0421 C�IECK ONE: IRRIGATION � DOMESTIC FIRELINE BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE: �ld� �- Sa.,��v Ia� � The bacl�low preveation asscmbly detailed below has bcea tested and maiatained as required by TNRCC rcgulanons and is certified to be operating within acceptable paramcters. TYPE OF ASSEMBLY C Raiuced Pressurc Principlc ❑ Pressurc Vacuimm Breaker � Doublc Check Valve o Atmosphere Vacuum Breaker Manufacturer (,�1 c�1-F-S S iu � fi Modei N�bcr f'�JQ� r✓�! l"�T Locaud At � �t��.r� �,� rr�z�r,�rr� S� Serial N�ber I�Q���I REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSi.TRE V ACUUM BREAI�R Double Check Valve Assembly lst Check 2nd Checl: Relief Valve Air Inlet Check Valve Inival Test DGClosed Closed Ti;ht � Opeaed at Opeaed at vsid Ti�t �,� � Leal�ed � Dsid osid ���5 �--�s�a � � �� ❑ ' ' Did not Opea D Leal:ed � �P� and Matet�ials Used Test Aftes DC-Closed Closed Tight 0 Opeacd at Opmod at __�sid Rtpair Tight ❑ �sid osid Rp sid The above is certified to be true. Firm Name A�I�ec� �Iv�✓ �,P�:c`UI�tS Cadfi�Testa � � Firm Address�� �i�X �l,�D P3'J,��Ir��,�r� Cert. TGster No. , : � � Date � _��� ?�f ��0�5✓ (�suge # E��7G,������ llate last accuracy tested r�.` ],.�' �y White - Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK ONE: IRRIGATION DOMESTIC FIRELINE ✓ BACI�LOW PREVENT'ION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PwS: CITY OF COPPELL PWS I.D. # � �, // �7�/' LOCATTON OF SERVICE: �Y( G� Sc�.�.�Ju /u��- �'aI. Thc bacl�low prcveation asscmbly decailed below has bxn testcd and maiatained as required bv TNRCC regulations and is cemfied to bc operating withia acceptablc paramcters. TYPE OF ASSEMBLY c Reduced Pressure Principle e Pressura Vacui�Breaker � Double Check Valve ❑ Atmosphere Vacuum Brealer �/L� t� Manufactsaer FP-�["'F� Sizc , Modei Number ��35� Locatcd At �ne a� �1a.��I-� Serial Nimiber ,�� `��1�°I � REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUIJM BREAKER Double Check Valve Assembly lst Check 2nd Checl: ReIief Valv� Air Inlet Checic Valve Inival Test DGClosc� Closed Ti�ht � Opened at Opeaed at osid Ti�t ���D � L�� o �sid nsid ��,C� RP-_psid �,� �d not ca o Leal:ed � � Leal;ed o �P �P� and Mataials Usod Test Aft,er DC-Closed Closed Ti,pht o Opeaed at Opeaed at �sid Repair Tight o �sid osid RP sid The above is certifiod to be we. Firm Name/���;� F�r�w �o,�r_.�"%��,'s�S Certifiod Tester �'.�� �rc.r'�`— Firm Address� 1�x ���b �►�t�/„n+l,,i+� f o( Cat Tester No. Date - /S ��c�s Gauge # �(�f� llate last accuracy tested ��- /�,- �� White - Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK ONE: IRRIGATION DOMESTIC FIRELINE /��- BACI�ZOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAIv�OF PWS: CITY OF COPPELL PWS I.D. # C�_// �.n,�r LOCATION OF SERVICE: 5�`�� �. S�1'� /a l.r�_ �r� The baclf]ow prevmtion asscmbly detailed below has been tested and maintained as required by TNRCC re�sulations and is cerdfied to be operating within acr.eptable paramcters. TYPE OF ASSEMBLY c Reduced Pressurc Principlc C Pressurc Vacu�Breaker � Double Check Valve o Am�osphere Vacuum Breal:er Manufacturer `e�� Sizc � �� Model Number �� Locaud At �r�i��l ����1�- Serial Nimmber �e�Z]� �I�6 S5 REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V�CUUM BREAI�R Double Check Yalve Assembly lst Check 2nd Checl: Relief Valve �lir Inl�t Check Valve Inirial Test DGCloscd�.� Closed Ti;ht e' Opened at Opened at osid TiQht Leal:ed ❑ �sid osid ���'j� RP"_psid � ,� �;� ❑ Did not Opea � Leal:e� � �P� and Materials Usod Test ARer DC-Closed Closed Tight O Opeaed at Opeaod at _nsid Repair Tighi ❑ �sid osid R.P sid The above is catifiod to be true. Firm Name �II�� FI�,,,� �a�c:;ul�`�t Cectified Testc /�►�'�L ' Firm Address�0 � �lS� /�:rllr�.1,�'an j�( Cat Tester No. Date—��'Z/ � 7Go�s Gauge #�IG�1 y/�y�j llate last accuracy tested C�,-►�-�� White - Customer's Copy Yellow - City Copy Pink-Tester's Copy