2016_0525 C�IECK ONE:
IRRIGATION � DOMESTIC FIRELINE
BACI�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATTON OF SERVICE: ��'7� ����Y�P '�lf"�
The bacl�low prcveatioa assembly detailed below has beea tested and ma�nta�n� � nq�� bv TNRCC
regulations and is cerdfied to be operating withia acceptable paramtters.
TYPE OF ASSEMBLY
C Reduced Pressure Principle C Pressurc Vacu�Breaker
� Double Check Valve o Amiosphere Vacuum Breaker
Maaufact�er �/ ��t r�S Siu �✓L�,�
Model Number �.� (� Located At � 1` �'-�-c ��Y
scrial N�mmbcr ��� ���'3
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Double Check Valve Ass�bly
lst Check 2nd Checi: Relief Valve Air Inlet Checic Valve
Inival Test DGClo�ed� Closed Tight �- Opeaed at Opeaed at _nsid
Tight � Leal:ed o �sid osid
RP-_psid ,
�;� p 2' Did aot Opea o L,eal:ed �
�P�
aad
Mataials
Usod
Test Aftet DC-Closed Closed Tight o Opeaed at Opeaed at __nsid
Repair Tight � osid _,_nsid „
RP sid
The above is catified to be true.
�
Firm Name Ol Accuracy Backflow ���T� � �Gj�Af�Py�
arton ircle
Firm Address Frisco TX 75035 Cert. Tester No. Date C ` � �y
9 2-699-7156
Gauge # /fL�l�i����
Date last accuracy tested /�?-?j�j-/�
White - Gnal�ew�-'s Copy Yellow - City Copy Pink-Tester's Copy