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2014_1230_RPZ C�IECK ONE: ,�� IRRIGATION DOMESTIC � FIRELINE �, �; BACKFLOW PREYENTION ASSEMBLY TEST AND REPOR? ; �: , _ � ' .NAME Q�PWS: CITY OF COP�,,�L�' ;�� y �� . ., . � , . _ . . : e , � - ; , ; . , ; _ .. � ;�, pWS I.D.#_ . ; , ,. • _ � � LOCATIOIv'OF SERVICE: ,��'��'� I�� ..�, �e� �'1 � � � � The bac�.-flow preveatiom asscmbly detailed below has bxa tesied aad ma�nta�*+ed as required bv TNRCC re¢ulanons and is cerdfied to be operating within acceptable paramcters. TYPE OF ASSEMBLY � Reduced Pressvre Principlc e Pressure Vacu�Breaker , � " Double Ch�c1�-��s� � ,Q , .. Aunosphere�Fa,cuuym Breal:cr � , _ :, . _ � � , y ,� + ,ti, � / �i'' ; �- , � Maaufact�ez t�`�. �;�.:�fi� � Siu r ! � �a 4-�� c.,� ' � -, f`� 1Vlodei N�ber �� '��'�"� Locatcd At '-�'� �J'- <--¢-�f� r`�� , , �};"'��.f t�� l i-�o sa;�r+�ba c� �l �S REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R _ Double Check V alve Assembly , ,: � , y ��,� 1st Cherk 2nd Checl: '. :'Reiief�alve Air Inlet . � Check Valve 4 - Initial Test DC-Closed `Closed Ti;ht � at Opened at esid ', Tisht � Leal:ed o (��-�-�sid �nsid RP-.�psid �i �' L,�;� ❑ Did not Open o Leal:ed � RePairs and . Materials U� � , � , i . � �. , . . .. . _ ,__ Test Aftes DC-Closed � Closed Tight o Opened Opeae�at � a� __�sid ` �. Repair Tight o �sid osid RP sid The above is certified to be true. � � � t",� J FirmNa**+�JVt�-(� {� t>Cl;:�-��/.�/ Certified Testa �OL'!t�.��t5 Firm Address �� Cat Testa No. � Date � ;; ��.�C� a,�� 1� `��-1' ;�.. , � :. (�suge # V'�C�� ` � _ ,,x llate last accuracy tested - White- Customer's Copy Yellow - City Copy Pink-Tester's Copy