2014_0730_RPZ (10) C�IECK ONE: 5 �
IRRIGATION DOMESTIC FIRELINE
BAC�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAIv�OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE:S r,�'Iar,%, f 7J 7E;L3�It/n�,&,� Can�a�/ �x �Sa��/
The bacl�low prevmtion assembly detailed below has beea tested aad maiatained as required by TNRCC
regulations and is cerdfied to be operating withia acceptable paramcters.
� TYPE OF ASSEMBLY
Reduced Pressure Principle ❑ Pressure Vacuimm Breaker
/� Double Check Valve o Amiosphere Vacuum Breaker
/� 't � r s ��
Maaufact�er 1�► Siu -2
Modei Number l��7�/�`7a'�' �.�_ Located At Y � �� Y >''d�/he.�S'��
Serial N�ber ��� R'�a r
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUiJM BREAI�R
Double Check Valve Assembly
lst C3eck 2nd Checl: Relief Valve Air Inlet Check Valve
Inival Test DGClosed Closed Ti,Pht Opened at Opened at osid
Ti� G Leal:ed o .,.�2 psid _nsid
RP- �=.IDsid �1�, C>
�;� ❑ Did noc Opea o Leal:ed �
�P�
and
Materials
Usod
Test After DC-Closed Closed Tight o ppeaed at Opeaed at �sid
Repair Tight ❑ �sid ____,osid
RP sid
The above is catifiod to be true.
Fi:m Name�C �`/�v �d•M/n Cerdfied Tesca � � Y r y �h'D�1�
Firm Address�'Q�i a7Gr�u����7G��! Cert. Tater No.��Ol�C15IGG� Date � .3L�
Gauge # 0 �U �,/G$�U'
llate last accuracy tested ,/�
White - Customer's Copy Yellow - City Copy Pink-Tester's Copy
. _ ��^��*�.;.