2016_0107 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: _� �A/7 (,� /' �lf�on�� .�� ' �.��%�,�
The bacl�low prevmtion asscmbly detailed below has beea testod aad ma�nta�n� � nq�� �, �CC
reguladons and is cerdfied to be opaating withia acceptable paramcters.
TYPE OF ASSEMBLY
e Reduced Pressure Principle e Pressure Vacuimm Brealcer
� Double Check Valve o Atmosphere Vacuum Breal:er
Maaufactsaer �'-�' �� � Siu � ��
Model Number `S.�� Locatod At �T�1`'-{-+� (�
Scrial Ni�ber �t��'1�1 i� �
m��.� .�,�->�-�I.zq
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V�CUUM BREAI�R
Double Check Valve Assembly
lst Check 2nd Checl: Relief Valve Air Inlet Check Vaive
Inidal Test DGClosed 3�'b Closed Tight .� Opened at Opeaed at _esid
Ti�t �P Leal:ed o osid __osid
RP-__psid Z�
Leal:ed o �' Did not Opea O Lesl;od �
�P�
aad
Materials
Used
Test ARet DC-Closed Closed Tight o Opeaod at Opeaod at �sid
Repair Tight o �flsid osid
R.P sid
The above is certYfied to be true.
Firm Name Oi Ae�urtcy Hh�l�ow Catified Testa ��I G9�P�1 I�,fh1 ���!r/1
oe i
Firm pddr�t Fri�eo,TX 7S03S Cat Tester No. Date�
972-69 -7 56
Gauge # (f �
Date last accuracy tested _f����f j�
White - Customer's Copy Yellow - City Copy Pink-Tester's Copy