2014_0813_RPZ (3) C�IECK ONE:
IRI�IGATION DOMESTIC � FIRELINE
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATIOIv'OF SERVICE: 7 75 IJ• I�t n,rc�n� t i►� �QD.#1c� 7�o � 9
The bacl,�flow przveation assembly detailed below has beea tested aad mainta�n� � nq� bv TNRCC
reguladons aad is ct:tified to be operating withia acceptablc parameters.
TYPE OF ASSEMHLY
� Reduced Pressure Principle � Pressurc Vacu�mi Breaker
� Double Check Valve ❑ Atmosphere Vacuum Breaker
Maaufacaaer �.��r5 Siu /
Modei Number L �r��y � z Locaud At l�'l �i�A lv I G�L �oo;M-
Serial N�ber � 3�79 `�
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Doubie Checic Va1ve Assembly
lst Check 2nd Checl: Relief Valve Air Inlet Check Valve
Ininal Test DGClosed Closed Ti;ht Opened at Opeaed at osid
Ti�t Leal:ed o 3 � � Dsid osid
RP- .i sid
Leal:ed p �, � Did not Opea O Leal:ed �
�P�
and
Materials
Used
Test ARer DGClosed Closed Tight o Opeaed at Opeaod at _nsid
Repair Tight ❑ �sid osid
RP sid
The above is certified to be true.
Firm Name �'r:A J7G�1 Ut �b4�k,�Go� Certifiod Tester �rt��s t�Pr�t�2 �,�F�o+L.p
Firm Address 1 y I l C �r+�.�y D 2 . ¢`��3 Cert Tcster No. ��D�I 3 3d� Date , -�3 13�-/y
C�rr�n-���Tv� ,;x 7sop7 ,'• ��,
L%'��G�-�,��!,l _`"
Gauge # 0$n yOS�3
llate last accuracy tested /� -�q -(�
White - Customer's Copy Yellow - City Copy Pink-Tester's Copy