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2013_1218_RPZCIIECK ONE: IRRIGATION DOMESTIC FIRELINE BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. LOCATION OF SERVICE: ar e--e-- a C v e4 4� 5&O 4 The bacl.-llow prevention assLm detailed elow has a ~and maintained as required by TNRCC regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY Reduced Pressure Principle r, Pressure Vacuum Breaker Double Check Valve C Atmosphere Vacuum Breaker q )4Manufacturer ,�i� l Q Tl.s Size y1-)- Model Number 0C) q Located At A r� Serial Number A ! Z 2 rl The above is certified to bed Firm Name '4 // P5 Certified Testa TY I,, "/,, Firm Address j /j/i /fit , 7 X ` e'le:t Testa No. Date Gauge # O001 %9V Date last accuracy tested White - Customer's Copy Yellow - City Copy Pink - Tester's Copy REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER Double Check Valve Assembly, Relief Valve Air Inlet Check Valve 1st Check 2nd Check Initial Test l DC- Closed Tidzt )k RP- psid Leaked Closed Tight o Leaked Omnod at sid Opened at vsid Did not Open o vsid Leaked Repairs Materials Used Test After Rtpair DC- Closed Tight RP sid Closed Tight Q ©' Opened at psid Opened at osid __ nsid The above is certified to bed Firm Name '4 // P5 Certified Testa TY I,, "/,, Firm Address j /j/i /fit , 7 X ` e'le:t Testa No. Date Gauge # O001 %9V Date last accuracy tested White - Customer's Copy Yellow - City Copy Pink - Tester's Copy