2014_0730_RPZ (2) C�IECK ONE:
IRRIGATION DOMESTIC FIRELINE
�
BACIQ�ZOW PREVENTION ASSEMBLY TEST AND MAINI'ENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE:��. a,�,� /7l� L; �/y�,y,c �c.� (��, n�c�/T ,SO/�
The bacl��low preveation assembly detailed below has beea tested aad ma�nta�n� � nq�� bv TNRCC
re_sulations aad is cerd5ed to be operating within acceptable paramcters.
TYPE OF ASSEMBLY
� Raiuced Pressure Principle C Pressur�Vacuimm Brealcer
^ Double Chxk Valve ❑ Atmosphere Vacuum Breal:er
/ I�
Maaufactsaer /. � � t.S Siu � �
Model Iv�ber (rj�lrl2l�� Located At Y� S'G' ►' 1'G�c�m �����,�
Serial N�ber /�� L/�lr
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V�CLTUM BREAKER
Double Check Valve Assembly
lst Check 2nd Checl: Relief Valve Air Inlet Cbecic Valve
Inival Test DGClosed Closed Ti�t e' Opcned at Opeaed at nsid
Tight � Leal:ed 0 .�,.�psid nsid
RP-�psid �-�
�;� o Did not Opea o Leal:ed o
�P�
and
Materials
Used
Test Aft,er DC-Closed Closod Ti�t o ppened at Opeaed at _�sid
Repair Tight o esid osid
RP sid
The above is cerafied to be true.
Firm Name
!/�i� _C�U ( �G'�I1 CC[n{lOd TCS1�Ci �ez Y Yi„� ,SC ��J(1/�:
Firm Address�'aD/2(Ay r r�+,�v��erx7��> Cat Testc No.��dG:?G(9 Date �/-� �
Gauge # C,��y�"% O�S(� �
Date last accuracy tested ,�/J� ��
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy