2014_1015_RPZ C�IBCK ONE:
IRAIGATION DOMESTIC FIftELINE
BACI�'LOW PREVENTION ASSEMBLY TES?AND MAINIENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: �a3� LRkEs,�beE ��
The bacl�low prevmtion assembly decailed below has beea tested aad ma�ntain� � nq� bv T'NRCC
regulations aad is cenified to be operaung within acceptable parameters.
TYPE OF ASSEMBLY
� Reduced Pressure Principle � Pressurc Vacu�Breaker
� Double Check Valve o Amiosphere Vacuum Breaker
Manufacz�aer u��*`�s Siu �o?"
Model Number �004/l93Q7 Located At v�D��2 !�E mAcef�a� gAere
L32H4�c.- t2o�^-
Scrial Ni�ber ��1//�0
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Double Check v alve Assembly
lst Check 2nd Checi: Relief Valve Air Inlet Check Valve
Inidal Test DGClosed Closed Tight ¢� Opeaed at Opeacd at osid
Tight � Leal:ed o S � sid _osid
RP-8'8 Dsid ,a
�;� ❑ � Did not Opea O Lesi►ed o
�P�
and
Materials
Usod
Test ARer DC-Closed Closed Tight o Opeaed at Opeaed at __nsid
Rapair Tight � Dsid __osid
RP sid
The above is ceetified to be true.
Fnm Name LG� �lu►+AB�n�G- Certifiad Testes �oNW-sr��nJ /1�lAD�so n1
Firm Addc+ess a`la Nq��o�Ac Cil� Cert. Te.ster No. 141�wls�s�, Date lo �s lao�`�
(�auge # 031316 b 5
Date last accuracy tested / a o/
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy