2013_0629_RPZCIIECK ONE:
IRRIGATION DOMESTIC �
FIRELINE
BACKFi.OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS LD. # 'C_12E5TS 1 l��
LOCATION OF SERVICE: I �3� C'�r- z��TS1C�P .
The bacl�low prevention assembly detailed below has been trsted and **+� +'+t��*+ed as required by TNRCC
regulatiotLS and is eatified to be operating within acceptable parmmeters.
TYPE OF ASSEMBLY
�� Reduced Pressure Principle C Pressure Vacutmm Brralcer
� Double Check Valve C7 Atmosphee Vacuum Breaker
Maaufactaser ��� Size � � 1
Modei Number W g Located At �r?'1 12!%'.- I t� � � �'?�r riS� C SZ_ ►�'� -
Serial Number �� ?c� �
The above is certified to be true.
Firm Nattte 1 P� fi=t � � rnr4�rrr:�3Rq Certified Tester — �''�'"'^ -'—: rC'1 GI'LCt -rEfB
// �
Firm Address' U - Pln�1q RIB _ Cert. Testa No. �OD! 1t-P (o Z Date �4L3
�-i-� wo�r -W� "T-i� '7rvI�L�
Gauge # O CTl �j {'1
Date last accuracy tested _ { � _ 'j • { 7_
White - Customer's Copy Yellow -City Copy Pink - Tester's Copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VACUUM BRF'A�R
Double Check Valve Assembly
1st Cheek
2nd Checl:
Relief Valve
Air Inlet
Check Valve
Initial Test
DC- Closed
Tight �
RP- �� sid
�� p
Closed Tight �
Leaked �
� _ �
Opmec� at
�- psid
Opeaed at
nsid
Did not Open O
nsid
Leaked '�
Repairs
and
Materials
Used
Test After
Repair
DC- Closed
Tight [7
Closed Tight o
Opined at
nsid
Opined at
nsid
nsid
RP sid
The above is certified to be true.
Firm Nattte 1 P� fi=t � � rnr4�rrr:�3Rq Certified Tester — �''�'"'^ -'—: rC'1 GI'LCt -rEfB
// �
Firm Address' U - Pln�1q RIB _ Cert. Testa No. �OD! 1t-P (o Z Date �4L3
�-i-� wo�r -W� "T-i� '7rvI�L�
Gauge # O CTl �j {'1
Date last accuracy tested _ { � _ 'j • { 7_
White - Customer's Copy Yellow -City Copy Pink - Tester's Copy