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2014_0808_RPZ (2)
C�IECK ONE: �� � 4 �IRRIGATION DOMESTIC ✓ FIRELINE '� ,�---- BACT�Z.OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAI�OF PWS: CITY OF COPPELL PWS I.D. # LOCATTON OF SERVICE: 1 ��1(� � �t/E?��7 Q V�" �1�C't,,U V The bacl�low prevmtion asscmbly detailed below has beea tested aad maintain� � nquired b�, T'NRCC regulations and is cerd5ed to be operating within acceptable parameters. % TYPE OF ASSEMBLY � Raluced Pressurc Principle ❑ Pressur�Vacu�Breaker ❑ Double Check Valve ❑ Amiospherc Vacuum Breaker Maaufact�uer �f-l�"'S Siu 3`� Modei Ivimmber ��� Locatad At =r1 r;i C�(P ��J. ��CG r�'l�✓ s«1�N�ba N b< I ��Co REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACULIM B R Double Check v alve Assembly lst Check 2nd Checl: Relief Valve Air Inlet Check Va1ve Initial Test DC-Closed Closed Ti;ht ❑ Opea at Opened at nsid Tisht o Leal:ed �� sid _�sid R.P-_psid ; Leaked c� Did not Opea D Leal:e� o F; �� f°,�7�t3t_C=ct' ��...}F_'�)Y,�,�' . � Mataials �a�'�� �:F��_��-t� =#� ,�. ; '�_ r � , �� .�� � __� C���c�k -(�y b✓� `��i Usod � �y�t��'' >r �C:_ Test ARer DC-Closed -Closed Tight Opea at Opmed at _�sid Repair Tight �psid __�osid RP •'� sid The above is catifiod to be�rue. Firm Name � -�C Catifiod Testa ��"F'.�l�r� �iS �l� � �� FirmAddress L�'rlii��i/l��T�J Cdt TestcNo. ate L'� Gauge # � �('} )(�_� llate last accuracy tested �-�- J� White- Customer's Copy Yellow - City Copy Pink-Tester's Copy