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2014_0923_RPZ (3) , � C�IECK ONE: � ___.� � Z IRRIGATION OMESTIC � FIRELINE � r �.� " BACKFLOW PREVENTION ASSEMBLY TEST AND MAINI'ENANCE REPORT � � NAN�OF PWS: CITY OF COPPELL. .. , ` . � � _ _ . PWS I.D. # � LOCATION OF SERVICE: �C� � • � � �� l�--' ,Gl ��1 "� �� The bacl�low prevention assembly detailed below has beea tested and r�t�ed as required by TNRCC regulauons and is cerdfied to be operating within acceptable paramcters. � � TYPE OF ASSEMBLY Reduced Pressure Principle C Pressure Vacu�Breaker D Double Check Valve o Amnosphere Vacuum Breaker ; � �e Maaufact�aer �'��G .S Siu " � Model Iv�ber ��Z � Y�� Located At ��"`��e+•.�l��_��'��`�C- Serial N�ber �Z.y�-Ly ,� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V�CUUM BREAI�R Doubk Check v alve Assembly lst Check �nd Checl: Relief Valve Air Inlet Check Valve Initial Test DGClosed Closed Tight 1� ed at Opened at csid Tight � Leal:ed ❑ �sid _�sid i�. . �- ` '7_Psia �, � �z1`�� ;� ❑ Did not Opea o L,eal:ed O �P� aad Mataials _ _ Usod . _ Test After DC-Closed Closed Tight o Optned at Opeaed at _�sid Repair Tight o nsid __..,nsid RP sid The above is cerufied to be trve. k {� �•.�� .,� � a j. FirmName �"ri nr-� �..c- �tG�Stc�,�.. ��w��sCecrifiedTesta ��>�f��c�5�1 .� �;` � E`z �t`��;: - Firm Address ��U� ` � ��I �'Z� Cert. Teste No. �'��`��+�.£��' r Date �,' '� °` ';' �.' ;�'_,f�t r�'r t'1 i��K t�fv(�=>�j .._, .. � „ Gauge # )�:��/ �� llate ]sst accuracy tested ��, :,u f_� White - Customer's Copy Yellow - City Copy Pink-Tester's Copy