2014_0923_RPZ C�IECK ONE: ��
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IRRIGATION OMESTI FIRELINE '
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u,..: BA�KFLaW PREVEIVTI�N ASSEMBLY TEST AND 11�AINTENANC'E REP4RT
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NAN�OF PWS:
CITY OF' COPP�� � �. �, `�
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PWS I.D. # �
LOCATION OF SERVICE: ��� h�� �{�c-��r_r _�,�} �D K,� ,
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The baclflow preveation asscmbly decailed below has beea tested aad maiatained as required by TNRCC
regulations and is certified to be operating within acceptable parameters.
� TYPE OF ASSEMBLY
' . 'f� , ��, �Reduced� suns � � le a �. 1 , C i P�esS�e V�Cutam Bteaker '-i i
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❑ Isouble Ch�ck jValve y � p ' t+�tmo here�Vac�um$ z � j ' �
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Maaufactiaer �u�5 Siu �Z
Model Ntimmber 0� Located At ..Dlr �)�����C)C
Serial N�ber ��3�'��
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V�CUUM BREAKER -;
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Doubie Check v alve Assembly :';
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1st C3eck 2nd`Checl: :Relief V alve Air Inlet Check Valve �!
Ininal Test DGClosed Closed Tight 0 Ope�d at Opened at csid
Tight ❑ Leal:ed o �sid _nsid
R.P-_psid
Leal;ed o Did not Opea o Leal:ed �
�P� i
. � . . � 41G` � .
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. ��U��� � �������� � �` �'�'��`��� � ,.��
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Test Aft,er DC-Closed Closod Tight � Opeaed at Opeaod at _�sid
Repair Tight �7( .,� 3 .S` sid _osid
RP 7� sid
The above is cerdfied to be true.
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Firm Name �r�n��f'��[,��(fs�ra,����::r"����>�'�`ertifiied Testa ,� �� �' � �'`t' " .�� �
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Dr�(��ZlDace z f #
Firm Address � �� Cat Teste Na ,
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Gauge # ���'����7
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Date last accuracy tested I �0 a
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy