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2013_1218_RPZ (6)CHECK ONE: IRRIGATION DOMESTIC FIRELINE BACKYLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: PWS I.D. # CITY OF COPPELL LOCATION OF SERVICE: The back-flow prevention regulations and is certified to be operating within acceptable parameters. Reduced Pressure Principle Double Check Valve Manufacturer A) Model Number D© � Serial Number &2-.-C3q,5 TYPE OF ASSEMBLY by TNRCC • Pressure Vacuum Breaker • Atmosphere Vacuum Breaker Size � Located At SUS 4; " c r �'.�it�Pr � n The above is certified to be true. Firm Name Certified Tee k 1 ^ N )L K Firm Address r r �' V/,Cert. Taster No. Date 0-1 43 Gauge # 0& 9 7Z Zez1 Date last accuracy tested ::Z�eq ,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 DC- Closed Tight Closed Tight Leaked � Op; peg at Opened at _nsid osid Pq ,55 RP-�sidX (P. 2 Leaked 0 Did not Open 10 Leaked O Repairs and Materials Used Test After DC- Closed Closed Tight o Opened at Opened at _-- nsid Repair Tight o nsid nsid 11 1 RP sid The above is certified to be true. Firm Name Certified Tee k 1 ^ N )L K Firm Address r r �' V/,Cert. Taster No. Date 0-1 43 Gauge # 0& 9 7Z Zez1 Date last accuracy tested ::Z�eq ,13 White - Customer's Copy Yellow - City Copy Pink - Tester's Copy