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2014_1230_RPZ (3) � ,�". C�IECK ONE: �i �� IRRIGATION DOMESTIC FIRELINE . BACI�ZOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT' r . „ ,NAME OF PwS: CITY OF COPPE�� ,��., ; , . � � . . � . ,. . � . _ . , - .. � R , . ` .� Pws i:D. � ; , � � � LOCATION OF SERVICE: ��5 �� S, �cD}�l t'�c�'k I �'� � `�"�� The baci.�flow preveation asscmbly detaile� below has bcea tested and maintained as required bv TNRCC reguladons and is cerdfied to be operating within acceptable paramcters. � TYPE OF ASSEMBLY Reduced Pressurc Principlc � Pressure Vacu�Breaker ^ Doublc C�heck Valx��.,,,_„� -, �o � . Atmospherc Vacuum Breal:er , , �., � � �.. __._ � � ; � �. ; � . . „ �,. ._ , , f w � � _,, _ , r,�� . . � �- � - , Maaufact�er Siu Model Number ��Q� Located At �-r' Scrial Nimmber 70��'i l�r� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER ;� Double Check Valve Assembly , : 1st Check ?nd Checl: Reli�f Valv� Air ldet Checic Valve `' Ini�al Test DGCloscd Glosed Ti,Pht � ed at Opened at � osid Tight �'° Leal:ed o �a�--�sid DS1d R.P- ��d�Dsid �f �;� ❑ Did not Opea o Leal:ed o �P� and Mataials Used � .. . ; , ;. , , � , , . _. , _ ._ _ , - � 0 „ _ Test Afttr DC-Closed Closed Tight o Opened ai Opmod at j _nsid Repair Tight ❑ �sid osid R.P sid The above is catifiod to be tnu. Fi:m Name 1� ��`{� I Sr.:�G��` Catifiod Testa ��h '�JGU�(� Fi:m Address � .�g� Cert Tester No. . ' � Date 1�� ' �1�`��` f'1��YU j - Gauge # C7 (?� ' � llate last accuracy tested �d- t°''/� White- Customer's Copy Yellow- City Copy Pink-Tester's Copy _ _ _ _