2014_1008_RPZ C�IECK ONE: �� � �
IItRIGATION DOMESTIC V FIRELINE
BACI�LOW PREVENTION ASSEMBLY TES?AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: lo23�I L�ncesNoe.� �,2
The bacl�low prevtation assembly detaile� below has beea tested aad maintain� � nq� �, �CC
regulations aad is cerdfied to be operating within acceptable parameters.
TYPE OF ASSEMBLY
� Reduced Presst�re Principle e Pressure Vacui�Breaker
� Double Check Valve o Atmosphere Vacuum Bnaker
Maaufacuaer GuJ4T-�S Siu ��o?`�
Model Number SS OD9 /�73�PT Located At BENn�rJ so�� �ilsi.��+r B�A�c �oo.+-ti
s«1�r+�ba /7a7�
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Double Check Yalv�Assembly
lst Check 2nd Checi: Relief Valve Air Inlet Check Valve
Ininal Test DGClosed Closed Tight � Opeaed at Opeaed at nsid
Ti�t � Leal:ed o y.� �sid _nsid
RP- ��8 Dsid
LeaI;ed ❑ Did aot Opea o L,eaiced O
�P�
aad
Mataials
Used
Test After DC-Closed Closod Tight a Opened at ppeaed at _�sid
Repair Tight o �sid _nsid
R.P sid
The above is catified to be t�ve.
Firm Name L6C /�CvMg�rvG Ce:tiSted Testa �To,�,�TNa� /1/1AA�s'o�J
Firm Addness�/� /�A�»e,.��e. (,�,�,�o Cert. Testc No. BPoors�3 9� Date / o$��o��
(�suge # 0313/6os
llate last accuracy tested D3 /$ o?o/
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy