2016_1130 C�IECK ONE:
IRRIGATION DOMESTIC FIftELINE
BACIQ�"1.OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAIv�OF PWS: CITY OF COPPELL
PWS I.D.# Wendy's
LOCATION OF SERVICE: 112 N. Denton Tap Rd.
The bacl�low prevention assembly detailed bclow has beea testcd and maintaincd as tequire� b�' TNRCC
regularions aad is certified to be operating within acceptable parameters.
TYPE OF ASSEMBLY
C� Reduced Pressure Priaciple C Pmsure Vacui�Breaker
y� Double Check Valve ❑ Am�osphere Vacuum Breaker
Maaufactsaer W ; ��:+�� Siu � y� `
Modsi Ivumber ��J��— _ Locaud At M�l" CAn ��`���" o��,Ao�.
$Cf13T T11�bG7
�� D�Ct2 1 c'✓�'1hc�>7 �At�'�, �fl�>
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BRLAI�R
Double Check Valve Assambly
lst Check 2nd Chec1: 'ef Valve Air Inlet C6eck Valve
Imtual�"�st DC-Closed Clostd Tight Opened at Opeaed at �d
" Ti � Leal:ed o osid osid
. ;���'�,� R.P�� � Dsid "� �
�� p � " � Did not Opea o Leal:ed �
RePairs
aad
Mataials
Used
rac� Dc-ci�a ci�a r,�c o o��a�c o��a�c fl�a
Repair Tight o �sid ��flsid
Rp sid
The above is catified to be we.
Fi�Name Allied Flow Specialists, inc. CatiSed Testa Christopher L. Coffman
�I ���PO Box 1150 Midlothian,TX 76065 ��,T�No. BP0016261 D� �/'���'��
�'�� Gauge # 05141063
Date last accuracy tested 7-21-16
White-Customer's Copy Yellow -City Copy Pink-Tester's Copy
C�IECK ONE: /
/
IRRIGATION � DOMESTIC FIRELINE
BACI�LOW PREVENTION ASSEMBLY TES'T AND MAINTENANCE REPOR?
NAI�OF PWS: CITY OF COPPELL
PWS LD.# Wendy's
LOCATION OF SERVICE: 112 N. Denton Tap Rd.
The bacl�low prevmtion asscmbly detaile� below has been testod aad maintaiaed as requir� by TNRCC
reguladons aad is certified to be operatmg within acceptable parameters.
TYPE OF ASSEMBLY
c/ Reduced Pressare Priaciple C Pressure Vacu�Brealcc
� Double Check Valve o A�osphae Vacuum Breaker
/�, _ �y�.,
Maaufactt�rer l���Co Siu
Modei Number �f�l�7A �.Y Located At r��-�e� ean ��c�- o� a��.
s«��N�b� L a3��
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Double Check valve Assembly
lst Check Znd Checl: Relief Valve Air Iniet Checic Valve
Inirial?est DC-Closed Closed Ti,rht Opened at Opeaed at nsid
Ti�t �� Lcaked o osid osid
��„�� Rp._Fsid ,
� p � y Did not Opea � Leal:cd �
�P�
aad
MateriaLs
Used
Test ARer DC-Closed Closod Tight o Opeaed at Opeaed at __flsid
Rtpair Tight o osid osid
RP sid
'Ibe above is certified to be true.
FicmName Allied Flow Specialists, �nc. Cctifie�Tester Christopher L. Coffman
I'', F1�A�SSPO Box 1150 Midlothian,TX 76065 Cert.TestetNo. BP0016261 D� �':��-�L'
II Gauge # 05141063
' Date last accuracy tested 7-21-16
� - o r's Yellow -Cit C -T
Wtute Cust me Copy y opy Putic ester's Copy