2014_1117_RPZ C�iECK ONE: /� � �
l
IRRIGATION DOMESTIC FIRELINE
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REppRT
rrAME OF Pws: CITY OF COPPELL
PWS I.D. # �Q�.�.s�,,�
LOCATIOIv'OF SERVICE: d/ L /1�'. aL ld.� �°-s�
The bacl�low prevmtion assembly detailed below has beea tested aad maintained as required by TNRCC
reguladons aad is cettified to be operating within acceptable parama�ta�s.
/ TYPE OF ASSEMBLY
•Q Reduced Pressure Principle � Pressur�Vacu�Breaker
� Double Chxk Valve ❑ Amiospherc Vacuum Breal:er
Maaufactsaer /_��� Siu ---�L
Modei Number cS�G�DI�'hol� cQ.T Located At � c���'
Scriai N�ber D9'Q�D
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Double Check v alve Assembly
lst C3eck 2nd Checl: Reiief�alve Air Inlet Check Valve
Ininal Test DGClosed losed Ti,�ht Opeaed at Opened at _nsid
Ti,i�t Leal:ed o , s- �sid _,nsid
R.P-�sid �'/_ C► �
I,eal;ed o Did not Opea o L,eaiced �
�P�
and
Mataials
Used
Test Aft,er DC-Closed Closed Tight o Opeaed at Opeaed at �sid
Repair Tight o nsid nsid
RP sid
The above is catified to be true.
Fnm Name � . � � �� Catified Testa
Firm Address ��- A`.x' �r��fl�T�Cert. Teste No. Date /�/7-/�
�7�.rOG��
Gauge # � � /(��'
Date last accuracy tested �'7 �/Z/.�
White - Customer's Copy Yellow - City Copy Pink-Tester's Copy