2016_0815 C�IECK ONE:
IRRIGATION DOMESTIC FIRELINE
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAIv�OF PWS: CITY OF COPPELL
PWS I.D. # 1��5 6�. 5 �O�1"t- �� �
LOCATION OF SERVICE: �� > I V - ��n"�� ►'1 1 � i ip hO '
The bacictlow preveation asscmbly detailed below has beea tested aad ma�n a�n� � nq� bv TNRCC
regulations and is cartified to be operating within acceptable parameters.
TYPE OF ASSEMBLY
� Reduced Pressure Principle ❑ Pressure Vacui�Breaker
� Double Chcck Valve o Atmosphere Vacuum Breaker
���.r !�
Manufact�uer O D Size � -
Modei Ntmmber � O �-O `� T �-- 5 Located At / v \��.� I�'O�J F'�
Sezia[N�ber � /�� �- $
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER
Double Check Valve Assembly
lst Check 2nd Checl: Relief Valv� Air Inlet Check Valve
Inival�est DGClosed Closed Ti�t j� ed at Opeaed at nsid
7 Tisht �I Leal:ed ❑ C�psid _nsid
��7 RP-�sid
�;� ❑ 7• �- Did not Opea � L,eal:e� O
��
and
Mataials
Usod
Test After DC-Closed Closed?ight o ppened at Opeaad at nsid
Repair Tight ❑ _nsid _osid
R.P sid
The above is cuafiod to be true.
Firm Name A I l- \ ei(''�— Certified Tester � �P.� �p�' ►��S�1
Firm Addc�e.ss a � 5 �� ��.S�.��1 Cert. Testc No. g����9�a D��l� 5/��
(cr,T�C
Gauge #O�07�7g �
llate last accuracy tested S ��1� b
White - Customer's Copy Yellow - City Copy Pink-Tester's Copy