2014_0808_RPZ (3) C�IECH ONE: ' �� � ����
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IRRIGATION DOMESTIC ✓ �
FIRELINE
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAIv�OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATTON OF SERVICE: I o�� S. t-1'E'�.i00Y�' �K t/,
Thc bacl�low preveation asscmbly detailed below has beea tested aad maintained as required b�, TNRCC
regulauons and is cerdfied to be operating within acceptablc paramcters.
TYPE OF ASSEMBLY
� Raiuced Pressure Principle C Pressurc Vacui�Breaker
^ Double Check Valve o Amnosphere Vacuum Breaker
Manufactzaer
W f=��'�S Siu " '�!
Model Ivumber L�a o9 Ma-�r Located At �
Serial Nimmber c��aa 8 3 8
�..r�
REDUCED PRESSURE PRINCIPLE ASSEMBLY "PRESSURE VACUUM BREAKER
Double Check v alve Assembly
lst Check 2nd Checl: Relief Valve Air Inlet Check Valve
Inival Test DGClosed Closed Ti�t Opea at Opened at csid
Ti�t Leal:ed o __?�.C�__psid _nsid
R.P-�•�sid
I,eal:ed o Did not Opea o Leal:ed o
�P�
and
Materials
Used
Test Aftet DC•Closed Closed Tight o ppeaed at ppeaed at _�sid
Repair Tight ❑ Dsid _,osid
R.P sid
The above is catifiod to be�ue.
Firm Name '�q ��C. Cadfiod Testa ��P V�'_1'l �i S Y�f�
����0�S '� -�G
Firm Address � �"<<��S Y%i�C 1 X.7�'9 Cat Tester No.��lYY1�7�}�ace���
Gauge # ���(����j�j'
Date last accuracy tested �-��"�' - ��
White - Customer's Copy Yellow - City Copy Pink-Tester's Copy