2014_0813_RPZ (7) C�IECK ONE:
IRRIGATION DOMESTIC C FIRELINE
BACI�"LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAIv�OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: 7 75 J�S. �t ns i o� j�rp �o ��d0 75D 1`i
The bacl�low preveation assembly detaile� below has bxa tesied aad mainta�n� � nq� bv 'I'NRCC
regulations and is certified to be operating within acceptable parameters.
TYPE OF ASSEMBLY
C� Reduced Press�urc Principle C Pressurc Vacut�Breaker
^ Double Check Valvc o Atmosphere Vacuum Breaker
:,
Maaufact�uer l��r�5 Siu 3�`�
Modei Ivumber L F D 0�7 ►'�3 Locatcd At 1� e/f����G A L /���
Scrial N�ber ��2 ��
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Double Check Valve Assembly
lst Check 2nd Checl: Relief Valv� Air Inlet Check Valve
Inival Test DGClosed Closed Ti;ht Opened at Opened at osid
Tidit Leal:ed o Z l_psid nsid
RP-�psid $ � �
�;� p Did not Open o Leal:ed �
�P�
and
Materials
Usod
Test Aft�et DC-Closed Closed Tight o Opeaed at Opeaod ac _�sid
Repair Tight ❑ �sid _osid
R.P sid
The above is certified to be true.
FirmName �'� ��Tc ue �.�c�i��o� CertiSedTestc �,�-�-�5 r�P��vL, �a���
Firm Address �`�I j L r r�R y ��- `�'�d� Cert. Tester No. I��a o e 3 30� Date '13—1
GAf��LliC.L'��7'N� 'i�,' 7�bD1
���
Gauge # G$D�I�S$3
llate last accuracy tested � (- (`�-(3
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy