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2014_0730 C�IECK ONE: IRRIGATION DOMESTIC FIRELINE BACI{F'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE: �Q� � � �� -�� p� The bacl�low preveation asscmbly dctailed below has beea tested aad maintained as required b�, TNRCC regulauons aad is certified to be operating within acceptable paramcters. TYPE OF ASSEMBLY C Reduced Pressure Principle ❑ Pmsure Vacu�Breaker �C Doublc Chxk Valve � Amiosphere Vacuum Breaker � Maaufacturer �r`'�� Siu � r Modei Iv�ber � � ��p�Located At �/��4 ��''` � � s«1�N�ba C� 3 79� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Doubie Cherk Valve Assembiy lst C3eck 2nd Chec{: Relief Valve Air Inlet C'6eck Valve Inival Test DGClose�,� Closed Tight � Opeaed at Opened at �sid Tight (�� Leal:ed o osid _osid D / RP-__psid 1� > Leal:ed ❑ /.� Did not Opea o Leal:ed O �� and Materials Usod Test Aftet DC•Closed Closod Tight o Opeaed at Openod at _T sid Repair Tight o �sid osid R.P sid The above is cerafiod to be we Firm Name Z�- �/ �fiod Testa ��'� � Firm Address IdG O '' �(�Eert. Tester No. � �0�.%��`^ Date Z- `� --�� y Gauge # rJ f Q U �l�b 1 llate last accuracy tested '" '7' 7 White- Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK UNE: IR.RIGATION DOMESTIC FIRELINE V BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE: ��` � s��; L,�-�� ,�� The bacl�low przvmtion assembly detailed below has baa tested aad maintain� � nq�d bv TNRCC re_gulanons and is cettified to be operating within acceptablc parameters. TYPE OF ASSEMBLY C Reduced Pressurc Principle ❑ Pressure Vacu�Breaker �` Double Check VaIve � Am�osphere Vacuum Breaker Maaufact�uer /'rl°�'�-S Siu � Model Iv�ber C n� 3 Ob �✓ � Located At �C t t�- /C � - Serial N�ber ^� � REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Check v alve Assembly lst Check 2nd Chec�: Relief�alve Air Inlet Check Valve Iniaal Test DGClosed �. Closod Tight Opened at Opened at osid Tight , Leal:ed o _osid _osid � r RP-__psid �S) Leai:ed � �� Did not Opea o Leal:ed � �P� and Mataials Usod Test Aft,et DC-Closed Closed Tight o Opened at Opeaed at _�sid Rtpair Tight o Dsid ____,osid RP sid The above is certifiod to be uue. Fnm Name � ^ � Certifiod Testa �� /�O a 2-- Firm Address ��i�i � � '��{ Cat Testa No. B��O!�b�g Date �• 3�'lG� Gauge # �{7��`��/ Date lsst accuracy tested 7��`� White- Customer's Copy Yellow - City Copy Pink-Tester's Copy C�iECK ONE: IRRIGATION DOMESTIC FIBELINE BACI�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REppRT NAI�OF PWS: CITY OF COPPELL PWS I.D.# LOCATION OF SERVICE: f�D/ � �k�v�'y ,C�� (1�' Tbe bacl�low preveation asscmbly detailod below has been tesitd aad ma�nta�n� � nQ� �, 'I'NRCC regulations aad is ce:ti5ed to be operating within acr.eptable parameters. TYPE OF ASSEMBLY C Reduced Pressure Principle C Pressure Vacu�Breaker 9� Double Check VaIvc o Amnosphere Vacuum Breaker Maaufactsaer N✓►��S Siu � Model Ivt�ber ��' �Q�A �� Located At ��5�✓.� /C Scrial N�ber Y�� ' �� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Check Valve Assembly lst Check 2nd Checl: Relief Valve Air Inlet Check Va1ve Inidal Test DGClosed Closed Ti;ht `�' Opened at Opened at osid �� Ti�i 'E� Leal:ed o nsid __nsid R.P-a'�Dsid Leal:ed o a!,� Did not Opea O Leai;ed ❑ �P� and Materials Used Test After DC-Closed Closed Tight o Opened at Opeaed at �sid Repair Tight ❑ �sid nsid RP sid The above is catified to be true. Fi:m Name ��C.�'1 iw'� ��p►w,�C.�� Catifiod Testa ��'L c�v 'L- Firm AddRss � ��3S �ur� �Q�Ie Cert. Testv No. � � �� Date��'�``� c�auge # aSp7,�1� � Date last accuracy tested - 7� White- Customer's Copy Yellow - City Copy Pink-Tester's Copy