2016_0525 C�IECK ONE:
IR.RIGATION�_ DOMESTIC FIRELINE
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: ��� � � Q� �/t'' '�1-
The bacl�low prevmtion assembly detailod below has bxa tested and maintained as required by TNRCC
regulations aad is cerdfied to be operating withia acceptable parametets.
TYPE OF ASSEMBLY
e Rcduced Pressure Priaciplc e Pmsurc Vacuimm Breaker
� Double Check Valve o Atmosphere Vacuum Breaker
� ��/�j �,
Manufact�er ��� I��✓�S S iu
Model Number ��D Located At fT�" �--'�t-C�
Scrial Ni�ber 5`' ��
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Double Check Valve Assembly
lst C3eck 'nd Chec.l: Relief Valve Air Inlet Checic Valve
Inidal Test DGClosed Closed Ti;ht � Opeaed at Opened at osid
Tight ��`1 Leal:ed o __Dsid _osid
RP-__psid ��,,
I,eai;ed ❑ Did not Opea o L,eal►ed O
�P�
aad
Mattrials
Used
Test Aft,er DC-Closed Closod Tight o Opeaed at Opened at __nsid �°
Repair Tight � flsid osid
RP sid
The above is cerafiod to be tcue.
Firm Name �1 Accuracy Ba�ckflow Catified Testa L-'/J9�'1G�.�71 UA91 �7�Iv�_�
Firm Addness Frisco,TX 75035 Cat Testc No. Date `S-�5`��°
Gauge #
Date last accuracy tested J�-�-/5
White- Copy Yellow - City Copy Pink-Tester's Copy