2014_0808_RPZ (4) C�IECK ONE: � � �
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IRRIGATION DOMESTIC FIRELINE
BACI�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATTON OF SERVICE: O o F p r
The bacicflow prevtation assembly detailed below has beea tested aad ma�n�a�n� � nQ� �, 'I'NRCC
regularions and is cerdfied to be operating witbia acceptable paramcters.
TYPE OF ASSEMBLY
� Reduced Pr�essurc Principle ❑ Pmsure Vacu�Breaker
� Double Chcck Valve o Atmosphere Vacuum Breaker
` - � ���
Maaufaetiaer W A�'�'.S Siu
Modei N�ber �� U�cl 1`�o�.�'(s�� Locat�d At �r�`.�`� I�l� ��. �. C U l�r"�:�"
Scrial N�ber C� l � 3�C�
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R � '
Doubie Check Valve Assembly
lst Check �nd Chec�: Reiief Valve Air Inlet Checic Valve
` Ininal Test DC-Closed ._ Closed Ti�t Opened at Opened at nsid '
Ti�t Leal:ed ❑ _�•� psid __esid
RP-�sid
Leal:od ❑ Did not Opea O I,eaked D
�P�
and
Mataials
Used
Test After DC-Closed Closed Tight o Opened at Opmed at �sid
Repair Tight o _osid _Y sid
RP sid
The above is catified to be true.
Firm Name i C, Certifiad Tester ��" .�' _�l I�' ` �,r�C1
C q3t��1 I
Firm Address Lrr p�i 5 v 1/��'.TT X��4��r Cat Tester No.��C_YY��i7d-� Date ' -��
Gauge # Q��L� � ��
llate last accuracy tested �-5 -/�
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy
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