2014_0923_RPZ (2) C�IECK ONE: , ��
IRRIGATION DOMESTIC FIRELINE
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BACI�I.OW PREVENTION ASSEMBLY TES?AND hZAI1VTENANCE REppRT
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NAME OF PWS: CITY OF�DPPELL �
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� . PWS I.D. # ,��
LOCATION F • I C� N � � �
O SERVICE. � � R
The bacl�low preveation asscmbly detailod below has beea tested and maintained as required b�, TNRCC
regulauons aad is cerdfied to be operating withia acceptable parameters.
TYPE OF ASSEMBLY
_ � Reduced Pressure Principle , ; , � Pressure Vacuimm Breaker
❑ ' Double Check`VaIve ` � ; p ' �h�o�pher�Vactium Bresket ' ' ° ¢
Manufactsaer ��-� Siu ���1-- � �
Model Number �� Located At -�'k �u.�`�,�_��3L
s«��t rr�va �b 3�$(o
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Double Check�%alve Assembly
lst Check 2nd Clucl: Relief Valve Air Inlet Check Vaive
' Inival Test DGClosed Closed Tight o Opened at Opened at csid
Tight ❑ Leal:ed o �nsid _nsid
RP-_psid
�f::; � Leal►ed o Did not Opea o Leal:ed J
RePairs
and ' s{ �„c�
� � C�u��C
Usod � C.��,,c�k- r. Cf�c c IL �1�r
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Test Aft�er DC-Closed Closod Tight �f ed at Opeaad at _�sid
Repair Tight � �,-Z Z- sid _nsid
R.P � � sid �
The above is certifiod to be true.
Fiim Name ri'm� �� '�i�'` c�er�� rs �,c, Catifiod Tester e v�e.� t.
Firm AddRs.s ��. A U �7 I Z Cat Testc No. ` �!� �J �I Da�e � r 3 /
� It�j ` �,� 7G�c��7 4
cauge � _�7,���7 -
llate last accuracy tested ? j0 /,3
White - Customer's Copy Yellow - City Copy Pink-Tester's Copy