2014_0730_RPZ (8) CHECK ONE:
IRRIGATION DOMESTIC FIRELINE (/'
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE:Sf /71�Y, n /J/7 f`, �/r/.i,c iP� C�,s,��//T 7i�C.�/9
The bacl►�tlow prevmtion assembly detailed below has beea tested aad maintained as required bv TNRCC
regulations aad is cectified to be operating within acceptable paramtters.
TYPE OF ASSEMBLY
�� Reduced Pressurc Principle C Pressure Vacui�Breaker
D Double Check Valve o Atmosphere Vacuum Breal:er
s 1 //
Manufact�er v�/�i �5 Siu �
Modei Number �%� �1/�.�G� 1 Located At �'o'S�,r rac� ��� �-�
Serial N�ber �o� G%`,� .�G�D
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Double Check Valve Assembly
lst Check 2nd Ch�cl: Relief Valve Air Inlet Check Valve
Initial Test DGClosed Closed Tight Opeaed at Opened at _osid ;
Ti ` Leal:ed o �psid __osid �
Rp_ • C9 sid f. Co �
I,eal;ed o ' Did not Opea o Leal:e� � O �
RePairs
and
Materials
Usod
Test After DC-Closed Closed Ti,ht o ppeaod at Opeaed at _�sid
Repair Tight ❑ �sid osid
RP sid
The above is ceKifiod to be true.
Firm Name /�I�' T`�� C.G�?/�� - Catifi�d Testa �� �. � {`� �C��G�%
Firm Address� :� 7 ► �° �� Cert. Tester No� � Q Date /-j� �� '
7��'�y'
Gauge # ���C L����� � �
llate last accuracy tested �
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy ;
u:w..::�.:� :