2014_0811_RPZ C�iECK ONE: �Y�YI-� � �.� ��-� .:, � �,;L. � ' _ ..
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IRRIGATION�_ DOMESTIC FIRELINE
BACI4'I.OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: �.. �7 C� I �� .° �rr.'� � �:''� ,
The bacidlow preveation assembly detailed below has beea tested sad ma�nta�n� � nq�� bv TNRCC
reguladons and is cerdfied to be operating withia acceptable parameters.
TYPE OF ASSEMBLY
�, Reduced Pr�essvre Priaciple ❑ Pressure Vacu�Breaker
� Double Chcck Valve o Atmosphere Vacuum Breaker
Maaufact�er � ' �`•�:� C.�:'� _ Siu �- `�
,- . � � �.
Model Ivumber �, ��. �.� Located At ��(��� � i,-� '�C c --��"���"� - ��-��.
�
Serial Nimmber
�--� �-� � `:~',�, � YYI;.:.�c-? �'
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Double Check Valv�Assembly
lst Check �nd Chec1: Relief Valve Air Inlet Check Valve
Inidal Test DGClosed Closed Ti,Qht ,{� Opened at Opeaed at osid
� � s ; ��,� Tight 1�, Leal:ed o Z ( �� �sid osid
RP-7-� psid
�;� a Did not Opea ❑ Leal:ed �
RePairs
and
Mataials
Used
Test After DGClosed Closed Tight o Opeaed at Opeaad at _nsid �
Repair Tight o �sid __,osid
RP sid
The above is certified w be true.
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Firm Name�-�"'� �.?�.�c� �. c �t�r�� Cerifiod Testc�--%�^�1� <� !� f � w r,.
Firm Address���� 1 �-� ;-�\,`� ''�� �`.'r-� Cert. Tester Na�`�+'u t,�U v �U U Date�
(i8llg@ � ''�.;+��;�..i� k 1 ���
llate last accuracy tested ~7 � �- � �L
White - Customer's Copy Yellow - City Copy Pink-Tester's Copy