2016_0727 C�iBCK ONE:
IRRIGATION� DOMESTIC FIRELINE
BACI�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
rraME oF Pws: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: ��� ���,�'.r �l'�'['�- (, /3�i .�;h �f��
The bacl�low preveatioa assembly detailed below has beea tested and maintained as required by TNRCC
regulations and is cerafied to be operating within accrptable parameters.
TYPE OF ASSEMBLY
C Reduced Pressvre Principle ❑ Pressure Vacuimm Breaker
� Double Chxk Valve ❑ Am�osphere Vacuum Breaker
Maaufacuaer G✓;���h� Siu
���
Modei Number 3�� Located At ��(I�r � I,J a.��"C
Serial N�ber �s"ar� 6 s�
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Double Check Valve Assembiy
lst Check 2nd Chec�: Relief Valve Air Inlet Check Valve
Initial Test DGClosed�-�� Closed Tight t� Opeaed at Openod at _osid
Ti�t t� Leal:ed ❑ osid _osid
R.P-_psid
Leal;ed ❑ 2 '9 Did not Opea O Leal;ed o
�P�
aad
Mataials
Used
Test After DC-Closed Closed Tight o ppeaed at Qpeaed at _�sid
Repair Tight o _csid osid
RP sid
The above is cutified to be true.
, �r
Firm Name ��, Certifiod Testa ���/t{������
F;,m pddress �'Bsrton Circle Cerc Tesw Na ?c� Dace 7�71�
risco, TX 75035
cauge # (�f/111✓�_
llate last accuracy tested�*'/`��J(y
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy