2014_0808_RPZ C�iECK ONE: �/ �
IRRIGATION DOMESTIC ✓ FIRELINE
BACI4Z.OW PREVENTION ASSEMBLY TEST AND MAIIV'I'ENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: I��C� S. ���e�O Y'� �1� 1 /.
The bacl�low preveation asscmbly detaile� below has bcea tested sad main a�n� � nq�� bv TNRCC
rcguladons aad is certified to be operating within ac,ceptable paramcters.
/ TYPE OF ASSEMBLY
ra' Reduced Pressvre Priaciple e Pmsure Vacu�Breaker
❑ Double Chcck Valvc ❑ Atmosphere Vacuum Breaker
� �i
Maaufacuaer �ll� f��`�"S Siu
Model N�ber 9 �7 ��Ar T r-� '�c�( %:S, � . C����v
Scrial Ni�ber �= C��C��
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACLTUM BREAI�R
Double Check Valve Assembly
lst Check 2nd Checl: Relief Valve Air Inlet Checic Valve
Initial Test DGClosed Closed Ti;ht Opeaed at Opened at osid
Tight Leal:ed 0 3•a psid nsid
RP- 9 �8�sid
Leal;ed o I}id aot Opea o Leal►ed o �
�P�
and
Mataials
Used
Test ARer DC-Closed Closed Tight o ppeaed at Opeaed at _�sid
Repair Tight o nsid osid
RP sid
The above is catifiod to be true.
Firm Name { nC,Certifiod Testa ��e V v1 l�i �� �f�
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o q C�
Firm Address i N�a�� �Y% 1 l�.T�(7��'7 Cat Testa No.��'Y`,��Date g �� ' 1 i-(
c�auge # C�`c� lb� C��`�
llate last accuracy tested ,,.� -�-)y
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy