2014_0730_RPZ (13) C�IECK ONE:
IRRIGATION DOMESTIC FIRELINE V
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE:�T /��,�,'„ /7/] ��/r��c,�,� C�a,����T ,?S`�:+/�
The bacl�low preveation assembly detailed below has beea tested aad maintain� � nq�� �, 'I'NRCC
rerQuladons aad is certified w be operating within acceptable paramctcs.
TYPE OF ASSEMBLY
� Reduced Pressure Priaciple ❑ Pressure Vacui�Breake,r
� Double Check Valve ❑ Atmosphere Vacuum Breaker
�r
Maaufactsaer l��� t`"7 5 Siu _ _ �
Model Number ��CX>l�l�C�7` Located At 1''r'S� �' Yc�r..,ya-i d�,f� ���/
s«;�N��a �l�2 33�
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER
Doubie Cbeck Valve Assembly
lst C3eck lnd Checl: Relief Valve Air Inlet Check Valve
Inival Test DGClosed Closed Tight Opeaed at Opened at nsid
Tight Leal:ed o �_psid �sid
RP-�sid /''�
L,ealced p "" r� Did not Opea O I,ealce� J
�P�
and
Mataials
Used
Test ARer DC-Closed Closed Tight o Opened at Opeaed at osid
�
Repair Tight o ��sid __osid
RP sid
The above is cerdfied to be true.
r
Firm Name/�°1.rr.� L��i-�= �Crasod Tesca J�r r� S'�a�'
Firm Address�'a/�i 2 � f:� .��r.:�c�,�G 9�'• Cat Tenar No:�Pcr-�$G�� Dace� v 1
c�auge # ��'D�/6 Sr'S D
llate last accuracy tested 3 j�L
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy