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2014_0731_RPZ ._....., ...: _.., ._..: ,..... � ,;x, r.,�.:. » .�.+._�nnr�aa.�ma r.. _.,z�„ .:s�°rvr5R'u�r2,aa�c...aw .xm� � a ..�..r��r.. .. . .-,,. ..��{R.r,r .. ., . ,.s . . . . . , , 1 +l.3 '�.., �9.:'�. C�IECK ONE: ' �� , , IRRIGATION DOMESTIC � FIRELINE BACT�'LOW PREVENTIOI�A5SEMBLY TEST AND MAINTEI�IANCE REPORT � - . NAME OF PwS: CITY QF COPPELL _ ', . . : .. - ., � � ' . .. . .. . . , .. � . . . .. . . . - . .. � � .. . ' . . ' M PWS I.D. # ; LOCATION OF SERVICE: �" ` i�t 'r�l' �°", f:j , l j�'r2 ;: ,�� '�' " �� '�j :a:� � �� , .� � �f,' l� �� The bacl�low prevmtion assembly detailed below has beea tesiod aad ma�ntain� � nq�� bv 'TNRCC re�ulations and is ceitified to bc operating within acr.eptable paramcters. � TYPE OF ASSEMBLY � � Reduced Pressurc Principle C Pressvre Vacu�Breaker � ^_ Double Check Valve __ � Atmosphere Vacuum Breaker i i , ; Manufacturer ``� 1 � i� ; �� `.� Siu � - �.. ;�l S � �_`� Model Number Located At �i��" i ; ;�'i" �`-" %'i't1 � ; � �� --�� -�, � r, :, � � r-J_^ �� :,{, Serial Nimmber � �� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Doubie Check v alve Assembly lst Check 2nd Checi: Reiief Valve Air Inlet Check Valve Iniaal Test DGClosed Closed Ti�t Ogened at Opened at �sid Ti�i �; Leal:ed 0 '� i.; �sid _osid � RP-�sid � L..� L.eaked ❑ �l ' Did not Opea o Leal:ed � �P� and Mataials Used _ _ , Test After DC-Closed Closed.Tight o Opened at Opeaed at �sid � Repair Tight o Dsid nsid RP sid The above is cerdfied to be tiue. �.�� ""'!'"" Firm Name � Ol Accurxcy BAclttlow Certifiiod Testa ��/�r'1 � ��•� % �:f�'f�il(�`-� � � Firm Address Friseo,TX 75035 Cat Tester No. '�f;��;� �, 1�";��_Date �`3�'�� Gauge # ��i�1�,��,1 l�ate last accuracy tested �;: -.:�x ;�'s� , White - Customer's Copy Yellow - City Copy Pink-Tester's Copy .. _ _ _ __ �..._ __ ._