2014_0813_RPZ (5) C�IECK ONE:
IRRIGATION DOMESTIC___�C __� FIRELINE
BACI�ZOW PREVENTION ASSEMBLY TEST AND MAINI'ENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: �1�S lU. Dt n��6-iJ 1�P �d��� �7SD?9
The bacl�low prevmtion assembly detailed below has beea tested 3ad maintain� � nq� bv 'I'NRCC
regulauons and is certified to be operating withia acceptable paramcters.
TYPE OF ASSEMBLY
C-� Rcduc�Pressurc Principle e Pressur�Vacut�Breaktt
^ Double Check Valve o Amiosphere Vacuum Breal:er
3�y `-
Maaufact�uer ��-T T 5 Siu
Model Iv�ber L F(?r99 vh� Locat�d At �1. �,c H�4 N��ft L ,Q c�v�i
Scrial Nimmber � � � ��7
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACU'iJM BREAKER
Double Check Valve Assembly
lst C3eck 2nd Cbeci: Relief Valve Air Inlet Checic Valve
Initial Test DGClosed Closed Ti;ht Opened at Opeaed at nsid
Ti¢ht Leal:ed ❑ 3. Z nsid osid
RP- •� sid �
�;� p $`� Did not Opea o I,eal:ed �
�P�
and
Materials
Usod
Test Aft�et DC-Closed Closed Tight o Opeaed at Opeaod at __nsid
Repair Tight ❑ �sid osid
RP sid
The above is cerdfiod to be true.
Firm Name .��'� A �-r► �t Q�k�Ce� Certified Tcsta C�t t2l 5 a D�tt E�2 Ci����.►�
Firm Add�ss I�I 1 C t w��y D►2 #�l�3 Ccrt Testc No. �P D D l 3 3 o co D��
C�+r��.��iro�, �,� �15007
��-C���'�
Gauge # �, $�y�s�33
llate last accuracy tested �l - I� ' I 3
White - Customer's Copy Yellow - City Copy Pink-Tester's Copy