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2013_1218_RPZ (2)CHECK ONE: IRRIGATION DOMESTIC FIRELINE BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE: May, c.,e t S+r4�-P 4 � 5� 700 N. [7�� �►� �P The back-flow prevention assembly detailed below has been regulations and is certified to be operating within acceptable parameters. XReduced Pressure Principle C Double Check Valve Manufacturer A) a AS Model Number ©� Serial Number A and maintained as required by TNRCC TYPE OF ASSEMBLY C Pressure Vacuum Breaker C Atmosphere Vacuum Breaker /,.;k Sizc Located At Pr 0 du &'-p s /� The above is certified to be true. Firm Name Firm Address 6�� 710z Gauge # 9)07/7P/- Date last accuracy tested 7—/ 1- Certified Tester yl<or "A.1 Cert. Tester No.,6 f�2 04 Date / 7--10q-13 White - Customer's Copy Yellow - City Copy Pink - Tester's Copy REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER Double Check Valve Assembly 1st Check 2nd Check Relief Valve Air Inlet Check Valve Initial Test 1 �Nl 9 DC- Closed Tight ❑ RP- O psid Leaked X, Closed Tight ❑ Leaked � Opened at _psid Opened at psid Did not Open o nsid Leaked ❑ Repairs and Materials �P �.14�h tor- t Used Test After Repair DC- Closed Ti , RP) O sid Closed Tight V 2.8 Opened at - O sid Opened at psid _nsid The above is certified to be true. Firm Name Firm Address 6�� 710z Gauge # 9)07/7P/- Date last accuracy tested 7—/ 1- Certified Tester yl<or "A.1 Cert. Tester No.,6 f�2 04 Date / 7--10q-13 White - Customer's Copy Yellow - City Copy Pink - Tester's Copy