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2015_1124 C�IBCK ONE: IR.RIGATION DOMESTIC FIRELINB BACI�Z.OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # %/L�,�,�5 '�OjPaDy LOCATION OF SERVICE: B[.� S- �i.�1�R.�c�.vi Q�u� T3e bacl�low preveation assembly detailod below has beea tested aad maintaincd as required by TNRCC reguladons aad is cerdfied to be operating within acceptable parameters. TYPE OF ASSEMBLY e Reduced Pressure Principle � Pressure Vacu�Breaker � Double Check Valve o Atmosphere Vacuum Bnakc Maaufact�aer l��i�',!i� Siu l�z Modei Ivumber �I /�-C_ Locaud At �? 7�.c�' ��,u /� r� Serial Nimmba Q,I f.�(2.yJ' � REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Doubie Check Valve Assembly lst Check 2ad Cbecl: Relief Valve Air Inlet Check Va1ve Inidal Test DC-C1osaJi losed Ti,Pht Opened at Opened at �id Tight�_r� ` Leal:ed ❑ Dsid �osid RP-_psid L,�;� o � � Did noc Opea o Leal:ed � �P� and Materials Usod Test Aft,er DC-Closed Closod?ight o Opeaed at Opea�at __..nsid Repair Tight o osid _osid RP sid The above is cerdfied to be tive. Firm N Cetified Testa �vy�'�`�7�� Firm A��-��- //.�7�?? ;a� � T!C_.Cert.Teste Na / Date/ —Z — "7(r�vl�5" Gauge # / llate last accuracy tested / L - /L -/ White- Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK ONE: IR.RIGATION DOMESTIC FIRELINE BACKFLOW PREVENTION ASSEMBLY TES?AND MAINTENANCE REPORT rr�OF Pws: CITY OF COPPELL PWS I.D.# �e.�.�� o�� LOCATION OF SERVICE: _ P�Z� �acl�r�ir.�.� i6/�s�• The bacl�low prevmtion assembly detaile� below has beea tat�ed aad maiatained as required bv T'NRCC re_�ulations aad is cerdfied to be operating within acceptable paramete�s. TYPE OF ASSEMBLY e Reduced Pressure Priaciple � Pressure Vacu�Breakcr � Double Check Valve ❑ Amnosphere Vacuum Breaker � �� Maaufacttaer ��-D Siu Model Nimiber ��0 Located At �i�.�r.�Tc�n bo:� o2��rir a�,r�f-p� Serial Ni�ber �./�9�/BD ��`' � ��'''� ��. REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACiJ[TM BREAKER Double Check v alve Assembly lst Check 2nd Checl: 'ef Valve Air Inlet Check Va1ve Initial Test DC•Cl ed losed Tight Opened at Opeaed at csid Tight � � ❑ Leal:ed ❑ �sid �sid RP-__psid � � L,eal;ed o Did aot Open o L,eal:ed � airs aad Materials Usod Test ARet DC-Closed Closod Tight o Opeaed at Opeaed at _�sid Repair Tight o nsid _,osid RP sid The above is cerdfiod to be we. Firm Name ,� `� �,T�.Cctified Testa �� Firm Ad X i^�'+�Cert. Testv No. 04�� Date l/�/.� 7�olas Gauge # A�'0�f l(.�C/'�l Date last accuracy tested� Z'/Z'/ White - Customer's Copy Yellow - City Copy Pink-Tester's Copy