2014_1217_RPZ C�IBCK �NE:
IRRIGATION DOMESTIC v
FIRELINE
BACI�'LOW PREVENTTON ASSEMBLY TES?AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: 4'�'��d��S ��I �• �wcv,ucthu c ���c�.
The bacl�low prcvmtion assembly detaile� below has beea tested aad maintained as required by 'I'NRCC
regulauons and is certified to be operating within acceptable paramcters.
� TYPE OF ASSEMBLY
Reduced Pressure Principle C Pressure Vacu�Breaker
D Double Check Valve ❑ Atmosphere Vacuum Breaker
Maaufactsaer ��t'� Siu �a-�
Modei Ivumber L��� �Q� Located At b� O� 5��l� �° �r �eqte�`
Scrial N�ber �J����
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Double Cherk Valve Assembly
lst Check 2nd Checl: Relief Valve Air Inlet C7ucic Valve
Ininal Test DGClosed Closed Tight ❑ ed at Openod at �id
Ti�t ❑ Leal:ed o .3 sid __nsid
��55 RP-�sid g.�'
Leal:ed ❑ Did not Opea o L,eal:ed D
�P�
and
Materials
Usod
Test Aftet DC-Closcd Closed Tight o Opeaed at ppeaed at �sid
Repair Tight O �sid _osid
RP sid
The above is cestifi�d w be true.
Firm Name/�II���10t^i' � ' �N►�- Certifiod Tescer f�s e� �, . �o�i�'1 ✓1
Fi�m AddrG4s P�� ���l1'1�d��ti�/l.� c«c. r�xo."�P oo i�a�� Da�e �-1�'-/
'7��5
cauge � ��1'`�I o(��3
llate last accuracy tested ��J�' l`f
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy