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2013_1218_RPZ (3)CHECK ONE: IRRIGATION DOMESTIC FIRELINE BACULOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE: 55Co 7oo Al. D-�-✓14v n The baclflow prevention assembly detailed below has been t�� d maintained as required by TNRCC regulations and is certified to be operating within acceptable parameters. Reduced Pressure Principle Doubgle r`ke k Valve Manufacturer Model Number 009 Serial Number � to 2-47 1 (O TYPE OF ASSEMBLY ❑ Pressure Vacuum Breaker ❑ Atmosphere Vacuum Breaker Y.2, Size Located At IPA 4z©� %�t°%J� �w7� r- 5; n The above is certified to be true. Firm Name All � 7L Certified Tester, Firm Address rU)br"4 i, 7Y 7 "at. Tester No. 4/ Date Z / Gauge # �*0717 ?-/ 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 1st Check 2nd Check Relief Valve Air Inlet Check Valve Initial Test DC- Closed Closed Tight ❑ Opened at Opened at nsid Tight ❑ Leaked )< �_psid nsid RP -,_ Dsid Leaked Did not Open ❑ Leaked ❑ Repairs and xle � b�� "-" r -- Materials �h Used Test After DC- Closed Closed Tight Opened at Opened at —.p sid Repair Tight 7' y n ' 2— �. OS psid Dsid RP std / The above is certified to be true. Firm Name All � 7L Certified Tester, Firm Address rU)br"4 i, 7Y 7 "at. Tester No. 4/ Date Z / Gauge # �*0717 ?-/ Date last accuracy tested White - Customer's Copy Yellow - City Copy Pink - Tester's Copy