2016_0815 (2) C�IECK ONE:
YRRIGATION � DOMESTIC FIRELINE
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NANIE OF PwS: CITY OF COPPELL
PWS I.D.# 1\ 5 �. S �0�1"�- �J �
LOCATION OF SERVICE: �� � I V - ���1�� ►'� Tf i ip �4 '
The bacl�low prcveation assembly detailed below has bxa tested aad ma�nta�n� � nq� bv 'I'NRCC
regulations and is cardfied to bc operating within acceptable parameters.
TYPE OF ASSEMBLY
C Reduced Pressure Principle ❑ Pressure Vacu�mm Breaker
''� Double Chxk Valve o tlmiosphere Vacuum Breaker
1 � � l ��
Maaufactiaer W i� �-► �1 S Siu ��-
Modei Number � �� Located At t-i�.�O S S t fb 1� � f i ve
s«��N�� A� �fi °I 5 7� �ti. c v e. � s��ee�+ �►�
bv s�S
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V�CUTJM BREAI�R
Double Check Valve Assembly
lst Check 2ad Checl: Reiief Valvt Air ld�t Checic Va1ve
Ininal�est DGClosed �.� Closed Tight � Opeaed at Opened at _nsid
Ti�ht l�i. Leal:ed ❑ __osid _nsid
��77 R.P-_psid a b
Leal:ed ❑ ' Did aot Opea � Leal:ed ❑
��
and
Materials
Usod
Test A,f3et DGClosed Closed Tight o pp��� ppm�a� esid
�
Repair Tight ❑ osid _osid
RP sid
The above is catified to be true.
Firm Name AI`�e�— Certifiod Testc I� �P'� �p-�'r�S O+'1
Firm AddrGss a- 6 5 �'� ���S����� Cert Testa No. g P���9�a D��I� Sl��
� <<�,T�-
�auge #O�07�7g �
llate last accuracy testea 5 �3'` �
White- Customer's Copy Yellow - City Copy Pink -Tester's Copy
C�IECK ONE:
IR.RIGATION DOMESTIC FIRELINE
BAC�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. # 1\ 5 6� 5 �O���- �J �
LOCATION OF SERVICE: �� � I V • ��n�� ►'� Tf i ip �O '
The bacl.�tlow prevmtion assembly detailed below has bxa tested and maintain� � nq� by TNRCC
regulazions and is cctified to be operating within acceptablc paramtters.
TYPE OF ASSEMBLY
C Reduced Pressure Principle ❑ Pressure Vacuimm Breaker
� Double Check VaIve o Atmosphere Vacuum Breaker
I -f ll
Maaufactiaer �" ��k � Size I
Model Number OtJ�V� I Located At ��-�O S S P�`� ���V �
S����� � a � �-5 � s�r-��� � � e�S��s
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUiJM BREAKER
Double Check Valve Assembly
lst Cherk 2ad Checl: Relief Valvt Air Inlet Check Valve
Inidal Test DGClosed (• � Closed Tight 1� Opeaed at Opcned at nsid
Ti,�ht 1�. Leal:ed o nsid �sid
��7 R.P-_psid �
Leal:ed ❑ l � Did not Opea o L,eai:ed �
��
and
Materials
Used
Test Aftet DC-Closed Close�Tight o Opened at Opeaed at _nsid
Repair Tight ❑ nsid __�vsid
RP sid
Tbe above is certified to be true.
Firm Name AI 1�e�� Catifiod Testa I� �P.� 2p�' ►r�S�+'1
Firm AddrGss a- 6 � �e�t ��.S�.��1 Cert. Tester No. g P���9�a D��l� Sl��
t�,T�.
�Gauge #O�O��7g �
llate last accuracy tested 5 �31` �
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy
C�iBCK ONE:
IRRIGATION DOMESTIC FIRELINE �
BACI{�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. # ��15 p� S �O���- �J �
LOCATION OF SERVICE: 7� S I V . ���l�rJ►'1 Tf i �(J �� •
The bacl�]ow przvtation assembly detailed bclow has beea tested and maintained as require� bv TNRCC
re_eulations aad is certified to be opera�ng withia acceptable paramtters.
TYPE OF ASSEMBLY
C Reduced Pressure Principle C Pressure Vacu�Breaker
'� Double Check VaIve � Atmosphere Vacuum Breaker
Maaufact�er �IM�C S _ Siu
3 ' '
Modei Number 4 '� � Q Located At f�� S-� Y�-�D�/''�
Scrial Nimmber J e '� I � S
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUZ7M BREAI�R
Double Check v alve Assembly
lst C3eck 2nd Chec�: Relief Valve Air Inlet Checic Valve
Inidal�est DGClosed Closed Ti,Qht �, Opeaed at Opened at nsid
� Tight 'J,(Q �, Leal:ed ❑ nsid �sid
��� �-__psid 3 ��
Leai;ed o Did not Opea o Leal:ed �
�P�
aad
Mataials
Usod
Test After DC-Closed Closed Tight a Opeaed at Opeaed at _�sid
Repair Tight o �sid osid
RP sid
The above is cerdfied to be true.
Firm Name AI`�e� Catifiod Testa t� �P-f �1��5 O+rl
Firm Address a- 6 5 �� �'.S�.��1 Cert. Tester No. g P�0��9 7 a D��I� 5/��
l�r,T�
Gauge #O'6 47�7g �
llate Isst accuracy tested S �3I! b
White - Customer's Copy Yellow - City Copy Pink-Tester's Copy