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2014_0730_RPZ C�IECK ONE: IRRIGATION DOMESTIC FIftELINE tf BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAIv�OF PWS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE:�I� I�I�rih I/�/7�!.`�e%-I:/�c _��r�r�,�sa/� The bacl�flow preveation asscmbly detailal below has bxa tesLed and ma�nta�n� � nq� bv TNRCC regulauons and is cerdfied to be operating within acceptable parameters. TYPE OF ASSEMBLY � Reduced Pressure Priaciple ❑ Pressure Vacu�Br�eaker � Doubla Chcck Valve o Auaosphere Vacuum Breal:er / � �� Maaufact�uez ��J� 1�T`S Siu � Model Ivumber �-��L'��92 G1 % Located At Y/f��'" Y�se.�rr�,P�/5 �/� Serial Nimmbrr .�J, T�, q �S �,�a/1 G' REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Check Valve Assembly lst Check �nd Checi: Relief Valve Air Inlet Check Valve Inival Test DGClosed Closed Tight �e' ed at Opened at �nsid Ti � Leal:ed o C��sid �sid RP�,psid -��'', �j/ Leal;ed 0 Did noc Opea o Leal:ed � Repairs aad Mataials Usod Test ARer DC-Closed Closed Tight o Opened at Opeaed at _osid Repair Tight � osid osid R,P sid The above is cerdfiod to be true. Firm Name��i er� �G�ey[. Certifi�Testes��e-r r u Sr`�if�� Firm AddressP��31�G71 r�✓�v,��T 7/0 r j<" Cert. Tester No./3t1'a o6$`GG 5` Date� Gauge #� �y e�fj 5,�,� llate last accuracy tested ."� !S// White - Customer's Copy Yellow - City Copy Pink-Tester's Copy _ _ � � __ _ _ __ � ,... ��_,.��,�-._v _ _ _