2014_0808_RPZ (5) C�IECK ONE: '(�
IRRIGATION DOMESTIC ✓, FIRELINE
BACI�'i.OW PREVENTION ASS�MBLY TEST AND MAIIV'I'ENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: I,��O S, t��Ei�C�Y� �k[�UV
The bacl�low prevmtion asscmbly detailed below has beea tested sad ma�ntain� � nQ� bv T'NRCC
reguladons aad is cerdfied to be operating within acceptable paramcters.
� TYPE OF ASSEMBLY
Reduced Pressure Principle ❑ Pmsur�Vacuimm Breaker
❑ Double Check Valve o Atmospherc Vacuum Breaker
Maaufact�er �� Siu
� ��
Modei Iv�ber �F<JO�r Ma'-C,�T �aua At �n S�c1e�rJ, E. C��r�er
s«��N�ba n a�� l�
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER �
Double Check v alve Assembly
lst Check ?nd Checi: Relief Valve Air Inlet Check Valve
Ininal Test DGClosed Closed Ti;ht Opened at Opeaed at _osid
Tight Leal:ed o �sid _osid
�- g� S�a
Leal;ed ❑ Did not Opea o Leal:ed �
RePairs
aad
Mataials
Usod -
Test After DC-Closed Closed Tight o ppened at ppeaod at _�sid
Repair Tighi o �sid _osid
RP sid
The above is certified to be true.
, __ , _ .-�,
Firm Name� � -� _.,�' • ' r`x', Certifiad Testa ���'.�l F` f1 �i �G�r`�
L1�1�-''j "�f�y -�*
�. �
Firm Address I F�=,�i,< v� i���T�"%����-y Cat Testc No. Date �+- � - 1'�
(=suge # �?�� ��'.� � ����"l
Date last accuracy tested :� --�1 -� �-�
White - Customer's Copy Yellow - City Copy Pink-Tester's Copy