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2014_0204_RPZCIIECK ONE: IRRIGATION DOMESTIC FIRELINE- BAMLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE: 1 -w �j �C,� rx The backflow prevention assembly detailed below has been tested and maintained as required by TNRCC regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY Reduced Pressure Principle ❑ Pressure Vacuum Breaker ❑ Double Check Valve ❑ Atmosphere Vacuum Breaker �tt Manufacnaerer`�S S Size 1 j j Model Number 4© [, (`� Located At �Lwio LA6 siviL �c�a� s� I'C> Serial Number The above is certified to be true. Firm Name K (ZO L) (10 k,��Qkl 50, Certified Tester ' sVf v'1 5 i Firm Address S,kl Cat Testa No. �� y �� Date � I OcAIC, Gauge # C1c� ®rr Date last accuracy tested I 1311q White - Customer's Copy Yellow - City Copy Pink - Tester's Copy REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER Double Check Valve Assembly 1st Check god Check Relief Valve Air Inlet Cheek Valve Initial Test DC- Closed Closed Tight ❑ t<t Opened at �psid Tight RP��'/,Q id Leaked ❑ Leak pp `j . C� - sid -mid Did not Open o Leaked ❑ Repairs and Materials Used Test After DC- Closed Closed Tight ❑ Opened at Opened at _ esid Repair Tight v psid _n sid RP id The above is certified to be true. Firm Name K (ZO L) (10 k,��Qkl 50, Certified Tester ' sVf v'1 5 i Firm Address S,kl Cat Testa No. �� y �� Date � I OcAIC, Gauge # C1c� ®rr Date last accuracy tested I 1311q White - Customer's Copy Yellow - City Copy Pink - Tester's Copy