2014_0813_RPZ C�IECK �NE:
IRRIGATION DOMESTIC � FIRELINE
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
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LOCATION OF SERVICE: `� �� �� Dt N�a N I.4P 2��. 7So J q
The bacl�flow prevmtion assembly detailed below has beea tested aad maiatained as required bv TNRCC
re_�arions aad is certified to be operadng withia acceptable paramcters.
TYPE OF ASSEMBLY
� Reduced Pressure Principle � Pressure Vacut�Breaker
� Double Chcck Valve o Atmosphere Vacuum Breaker
Manufactiaer �A r T S Siu ��� ,�
Model Iv�ber L F��y� z Located At ►M, t c n d���c:,a� �-vo-�
Scrial N�ber D�S�o z
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER
Double Check v alve Assembly
lst Check 2nd Chec1: Relief Valve Air Inlet Checic Valve
Initial Test DGClosed Closed Ti,Pht Opeaed at Opeaed at nsid
Tight Leal:ed ❑ Z -`� nsid osid
RP- �L sid
�;� o �s� Did not Opea o Leal;ed �
�P�
and
Mataials
Used
Test Aftet DC-Closed Closed Tight o ppene�at Opeaed at _�sid
Repair Tight a nsid _^osid
RP sid
The above is cerdfied to be true.
Firm Name �+'/� �4�r►�t �o4-GKGLC� Certifiod Testa �►���S�o-P�tE2 G a i�Fo.c.�D
Firm Address t Nl i ��c.+.1�+Y �D�. �`�0 3 Cert. Tester No. �PtrG I 3,3 c7(v Date �3- �3'
G h�--►2-0�L Ta�-►� , i Jc 7SOn 7
Gauge # p�o y es v�
llate last accuracy tested �� - I� - I 3
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy