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2014_0808_RPZ - , _ ,._, .. : . ., �,. C�IECK ONE: IR.ftIGATION DOMESTIC � FIRELINE -� ,. �.�. ' BACIQ�'LOW PREVENTION ASSEMBLY T'EST AND MAINTENANCE REPORT' NAME OF PWS: CITY OF COPPELL PWS I.D. # LOCATIOIv'OF SERVICE: �„n,m�� rv�e Q!�• The bacl��low prevmtion asscmbly detailed below has baa iesied aad maintain� � nq� by TNRCC regulauons aad is cerdfiad to be operating within acceptable parameters. TYPE OF ASSEMBLY � Rcduced Pnssure Principlc � Pressure Vacutmm Breaktr ^ Double Chcck Valve � Amlosphere Vacuum Breaker Maaufactzaer V+IAT;�; Siu 4~� ' Model Number �� Located At WoRt` s�i�P Serial Ivimmber i g`� a�� a- REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Chetk Valve Assembly ' ' : _ . 1st�Check 2nd Checl: Relief Valve Air Inlet Check Valve Inival Test DGClosed �- � Closed Ti;ht Opened at Opeaed at osid +�� , ; Ti�ht � Leal:ed 0 �'p �sid nsid RP-_psid �� ❑ Did not Opea o Leal:ed � RePairs and Matrrials �' Used Test After DGClosed Closad Tight o Opeaed at Opeae�at _nsid Repair Tight ❑ osid _osid R.P sid The above is catifiod to be we. Firm Name� � 4 i-� f � C�t,� Certifiod Tester ��/�a Firm Address,�C� D� hl a-�i��+►ct � ��Gc�Cert Tcster No.��j C�0_�7��ate_� , tiauge # f�Sf� �.�'rl �`r �" YDate last accuracy tested /- 6- �D 1 y � White- Customer's Copy Yellow - City Copy Pink-Tester's Copy