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2016_0715 C�IECK ONE: IRRIGATION DOMESTIC FIRELINE BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT rr�OF Pws: CITY OF COPPELL PWS I.D. # � �a - 3 g 3 —�8g� �.. LOCATION OF SERVICE: �� - C�'<l • I��1 F' � ��-=�c� � 7 '��'c=� '��l� 'Ibe bacl�low prevmtion asscmbly detailed below has beea testcd and n'+aintain� � nq�� by TNRCC reguladons aad is cerdfied to be operaang withia accaptable parameters. TYPE OF ASSEMBLY ,� Reduced Pressure Priaciple C Pressure Vacu�Breaker ❑ Doublc Chxk Valvc � Atmosphere Vacuum Breal:er i �� Maaufact�er �� _ Siu �� Modei N�ber �..F-=�i�� Located At �.�'�-t' '�-�'Y"�►'1 Scriai N�ber ��'�_� �- REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Check v alv�Assembly lst Check 2nd Chec�: ReIief Valve Air Inlet Check Vaive Initial Test DGClosed Closed Ti;ht �tf Opeaed at Opeaed at osid TiQht J�. L�� , f � �Psid osid R.P- �'� sid L,�;� ❑ Did not Opea o Leal:ed � �P� and Materials Used Test Aft,er DC-Closed Closed Tight o Opeaed at Opeaed at _osid Repair Tight o ��sid osid RP sid The above is certifiod to be true. Firm Name ��f�-1�-,._� �A�.-L�F"�t�?� Certified Tcsta `�, P�J��/�l��'r /�` Firm Address er?2 Z l��"n1 cl��/'� � Testa No. '. � � Date 7- ! � -,/� _'-� �'��-� (�f 7L� Z�-,�- Gauge # _1 � �f Ll?�/l_=T llate last accuracy tested f '-t �j_-f�, White - Customer's Copy Yellow - City Copy Pink-Tester's Copy