2014_0730_RPZ (7) . . . . . _.. ,,. , _�.. . .�y ����,. „,:'t . , . ..ti.
C�iECK ONE:
LRRIGATION DOMESTIC FIftELINE �/�
BACI4Z�OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D.#
LOCATION OF SERVICE:._a t,_IrIR r,�n /7/7 � �/tfi h C/E'c� �'o,�,o�//T ?SG'/��
The bacl►�tlow preveation assembly detailal below has beea tasted aad maintain� � nq�� � '�CC
regulazions and is certified to be operating within ac�eptable parameters.
TYPE OF ASSEMBLY
¢� Reduced Pressvre Principle � Pressure Vacut�Breaktr
D Double Check Valve o Atmosphere Vacuum Breaker
Maaufactsaer �u �rS S iu _ _,� ��
Modei Number liGz�llyl��i� Located At Y >�� ✓ Yc'�i��r ls/� ��.�
Serial Iv�ber �!�j '� �/�,
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACU[TM BREAI�R
Double Check v alv�Assembly
lst Check 2nd Cbec�: Reiief Valve Air Inlet Check Valve
Iniaal Test DC-Closed Closed Tight Opeaed at Opeaed at nsid
Ti� ,2 �7 Leal:ed ❑ �.�a psid _nsid ;
R.P-!,psid , �p
Leal;ed o � Did not Opea O Leal;ed o �
RePairs
and
Matcrials
Used
Test After DGCloscd Closod Tight o Opened at ppeaed at _nsid
Repair Tight o �sid _osid
R.P sid
The above is catifiod to be ttuc.
Firm Name��= rYU �o/�N! Certifiad Tesca �� r r� .�c �dc�,�
Firm Addi+ess�r�/.�G7�rr��GP/i G� Cert. Testet No.�� Da�e lJ �
�1.�G9 y ��'G'od��ri�J
(�auge # C;?�'0 y l� `� C�
llate last accuracy tested S✓ L
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy
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