2014_0730_RPZ (6) C�IECK ONE:
IRRIGATION � DOMESTIC FIRELINE �/
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PwS: CITY OF COPPELL
PWS I.D.#
LOCATION OF SERVICE: -ST, ��'„ �-i'r� / �/7 L� ,/�'�/r��;r c �'� �S o/ y
The bacl�flow prevmdon assembly detailed below has baa tested aad maintained as requirod by TNRCC
re¢uladons and is cerdfied to be operating withia acceptable paramcters.
TYPE OF ASSEMBLY
� Raiuced Pressure Principle � Pressurc Vacu�Breaker
^ Double Chxk VaIve � Atmosphere Vacuum Breaker
� //
Maaufact�er G-t�`:S Siu
Modei Ivumber i��4/yP ;� �T Locaud At Y1 S(� �' Yao/� �1�. ��
s«��N�ba /�.d k� 7
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Double Check v alve Assembly
lst Check 2nd Checl: ReIief Valv� Air Inlet Check Valve
Inidal Test DGClosed Closed Ti;ht ed at Opened at osid
Tighi Q � Leal:ed o ���sid nsid
� RP- �� Dsid �,Q' �
� ❑ Did aot Opea o Leal;ed O _..
�P�
aad
Mataials
Used
Test Aft,er DC-Closed Closed Tight o Opened at Opeaed at __�sid
Repair Tight o csid _osid
R.P sid
The above is cati6ed w be true.
Firm Name �C'.�rr0 �C/y!/�'1 CatiSed Testa �L� Y� SC A o�G-
Firm Addc�ess 6°c��312�7 r.'s r� vr¢� �1r Cat Taster Nol��`'����'�l�� Date 7 3� /
�����
Gauge # � 4TC7 y0 9.SG
Date last accuracy tested���
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy
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