2014_0729 C�IECK ONE:
IRRIGATION� DOMESTIC FIRELINE
BACKFLOW PREVENTION ASSEMBLY TEST AND MAIIVTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: e r� �a tJ
The bacl�low preveation assembly detailed below has baa testod aad maint�� � nquired by TNRCC
regulations and is certified to be operating within acceptable parameters.
TYPE OF ASSEMBLY
C Reduced Pressure Priaciple � Pressure Vacu�Breaker
,,0� Double Check Valve o Atmosphere Vacuum Breaker
Maaufactsaer ��c� Siu ���' (
Model Number `a �� Located At �rAe�c � �-1�O�
Serial N�ber f/ C �� � �6
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V:�CUUM BREAI�R
Double Check Valve Assembly
in(ycek �nd Checl: Relief Valve Air ldet Check Valve
Inival Test DGClosed�� Closed Ti�t� Opened at Opened at osid
Tight Lcal:ed 0 nsid _,osid
R.P-_psid �'
�� ❑ Did not Opea o L,eakod �
�P�
and
Mataials
Usod
Test ARer DC-Closed Closcd Tight o Opmod at Opeaed at _._flsid
Repair Tight ❑ vsid osid
RP sid
The above is cerdfiod to be true.
Firm Name S�/v`� '�g�o�P Catifiod Testa��� ( �'�
Firm AddrGss �o �G� �oa�s'S��/.�T� Cat Tesw No.� a r�� U Dace � � �/
(�auge � D�/3/��5��
llate last accuracy tested
Whi.te - Customer's Copy Yellow - City Copy Pink-Tester's Copy