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2014_1230_RPZ (2)
.,._ ... . .. :«. . ,.., .,.., *a-�.., ...,.,s, .t.:,. ., . . .. .:..,,.Av ,s ' .. p . � ..X, . . C�IECK ONE: �� IRRIGATION DOMESTIC �� FIRELINE ` BACI{F'I.OW PR�VENTION ASS�MBLY TEST AND MAINTENANCE REPORT � r : � NAIv�OF PWS; CITY OF COPPE�� � _ -', � _ �; F; PWS I.D.#' ,;. ,r� � � .��'� � �, LOCATION OF SERVICE: �-.Q�s �a�% S, / �'��..�,�1 � �,��? � j(� The bac�l�low prevmtion asscmbly detailed below has beea tested aad maintained as required by TNRCC re_Qulations aad is cerdfied to be operadng within acceptable paramcters. TYPE OF ASSEMBLY � Reduced Pressurc Principlc C Pressure Vacu�Breaker � Doublc C�eck Valve .�__,. -- : � � Atmosphere Vacuum Breal:er = -,�__ , _.3 , : , , ` ,2-- _ -, _ � . _� - _ Maaufactsaer J� Siu l , Model Number ��� Located At " (l `--J G(,,'l�� s��N�ba ����' � �'� ; y � �� - 5 �; --�,�.:, REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACWM BREAI�R :�; . Do�ble Check Valve Assembly , - ;u lst Check 2nd Checl: Releef Valve Air Inlet Checic Vah►a Inival Test DGClosed Closed Tight d at Opened at osid Tisht �' � Leal:ed o �psid osid R.P- �/ Dsid �' L,�;� ❑ Did not Opca o L,eal:ed O �P� aad Matcrials Used ; � � . _, , � Test After DGClosed Closed Ti¢ht a Opened at Opeaod M , __�sid ' Repair Ti,Qht o �sid osid RP sid The above is cadfiod to be true. � � ' Firm Name J�,..����'��5 �� �-I�X,..� Certifiod Tester ---,b b1 �°,.(�lS F�p�s � � �-�(� �f � ^`� Cert.Testa.No.���('� '��1.,�i�ate��/� . ,�,Q�/''f at✓11 �°�P r�' %��D"7 .�: . � � Gguge # ��'t��l J���e� llate last accuracy tested � � White- Customer's Copy Yellow - City Copy Pink-Tester's CoPy _ _