2012_0126_RPZCIIECK ONE.
IRRIGATION
DOMESTIC
FIRELINE
BACKFZ.OW PREVEN'T'ION ASSEMBLY TEST AND MAII�TI'ENANCE REPORT
NAME OF Pws: CITY OF COPPELL
PWS I.D_ #
LOCATION OF SERVICE: � ' S s �� �s % -S � °�� �'� � � !` esk�5� �� �ac . (:� � e s
The bael�low prevention assembly detailed below has been tasted and rna;nrained as 1'CCjllired by TNRCC
nsuladons sad is certified to be operating within acceptable parameters.
TYPE OF ASSEMBLY
[a-� Reduced Pressure Principle C Pressure Vann***+ Breaker
� Doubic Check Valve O Atmosphere Vac-tn�**+ Breaks
" / �/ �
Maaufacttaer �^�'�' ��` � �' s Size
Modei Number �` � S Located At l %' '! � �'JG'� �'L ^"� �GG/Y7
Serial Number � �� (,'� d �' ; �% � 7d %
The above is certified to be true.
Firm Name i -�� �'"� ;'r ��� �'�, �'�� � �
Firm Address !'`> `ice /% < <�� �J`� � '6 c� �-
Gauge # � -S� � � G �7 S
Date last accuracy testes
White - Customer's Copy
� /G � %�
Ceztified Tester � ' � �� �' � � ��
Cent Tester No. l= I GG %/ '�%G Date / ` �= �� /ol
Yeuow -city copy Pink - Tasters copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VACUUM BRE_��'R
Double Cheek Valve Assembly
1st Check
2nd Check
Relief Valve
Air Inlet
Cheek Valve
Initial Test
DC- Closed
Closed Tight
Opined at
Opined at
nsid
�j -
/ ��C,
Tigiu : � , r o
:.
Leaked [7
nsid
nsid
RP- nsid
�;. , t�
_
`" C
Leaked p
"
Did not Opm O
i r +l -rri �
Repaus
and
Materials
Used
Test Aiiar
DC- Closed
Closed Tight o
Opined at
Opened at
nsid
Repair
Tight o
esid
esid
RP sid
The above is certified to be true.
Firm Name i -�� �'"� ;'r ��� �'�, �'�� � �
Firm Address !'`> `ice /% < <�� �J`� � '6 c� �-
Gauge # � -S� � � G �7 S
Date last accuracy testes
White - Customer's Copy
� /G � %�
Ceztified Tester � ' � �� �' � � ��
Cent Tester No. l= I GG %/ '�%G Date / ` �= �� /ol
Yeuow -city copy Pink - Tasters copy