2014_0813_RPZ (4) C�IECK ONE:
IR.RIGATION DOMESTIC X FIBELINE
BACICFT.OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
rraME oF Pws: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: 77.5 1�.�. t�n t N r BJ�J �}(� Q r� �10� � p � �j
The bacl�low preveation asscmbly detailod below has beea tested and maintained as requind by TNRCC
regulations aad is certi5ed to be operating within acceptabla parameters.
TYPE OF ASSEMBLY
� Raiuced Pressure Principle ❑ Pressurc Vacuimi Breakar
� Doublc Chcck Valve D Atmosphere Vacuum Breaker
3�y �,
Manufactsaer �-�r�S Siu
Modei Number �, ic 0�`I vt��3 Locatad At G���c�i-�4�v���L Q o-e r,�
Scrial Nimmba 3 g y o r
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V�CUUM BREAI�R
Double Check Valve Ass�bly
lst C3eck �nd Checi: Relief�alve Air Inlet Check Valve
Inival Test DGClosed Closed Ti;ht Opened at Openod at �sid
Tight Leal:ed ❑ 2��$ �sid �sid
R.P-�„�` psid
j,�;� p �`v �" Did not Opea O Lealced D
�P�
and
Mataials
Used
Test After DC•Closed Clos�d Tight o Opeaed at Opeaod at _nsid
Repair Tight a �sid osid
R.P sid
The above is catifiod to be true.
Firm Name �{:� �c;�vE l�,�c�ca=co� Catifiod Testet C��s�e�t+E2 �1,�►�Fo-o��
Firm Addr�ess 1�I 1 I L t✓i►.�Y ��. `�`�a� Cert Tester No. �Q o o� 3 3 0(, Date `�- I 3 _
�,eL 2�2 G L L 1'�I�, l,1' �]SD(�� �i"—' `'
�1.�
Gauge # ��$�yDS��
llate last accuracy tested j �- �°� -�3
White - Customer's Copy Yellow - City Copy Pink-Tester's Copy