2014_0922_RPZ C�IECK ONE: .� � �
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IRRIGATION DOMESTIC v FIRELINE
BACI�LOW PREYENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. # �Dr�r1 '�Y�A,W�h
LOCATIOIv'OF SERVICE: ��( � (� . 1'Y10�c_ 1�r-�-�n.�.�r 7 �3� `
The bacl�low prevmtion asscmbly detailed below has been tested and ma�n a�n� � nq�� bv TNRCC
rcguladons and is ccrtified to be operating within acceptable paramcters.
TYPE OF ASSEMBLY
� Reduced Pressurc Principle ❑ Pressure Vacu�Breaker
^ Double Chcck Valve a Amnospherc Vacuum Breal:er
Maaufact�er W0�*�5 Siu ��?�
Model Number �- L��C')�! Located At C_O .�o
Serial N�ber o2.� ���
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACULTM BREAKER
Double C3eck Valve Assembly
lst Check 2nd Checl: Relief Valve Air Inlet Checic Valve
Inival Test DGCloscd Closed Ti�t � Opened at Opened at nsid
Ti�h.t � Leal:ed ❑ 3.`f" psid osid
RP-�psid 2
I,�;� a �` Did not Opea o Leai:ed J
�P�
aad
Materials
Used
Test Aft�er DGClosed Closed Tight o Opeaed at Opeae�at nsid
Rtpair Tight ❑ �sid osid
RP sid
The above is c«rifie�to be true.
Firm Name lw� Fi.►=c..�-Cl►�a'R b�cTLrO� Certified Tasta
1.
Firm pddre.Ss�O d t�e'"1�-l� Cert. Tester No. �ODI'�`�f�`S Date � � -1�(
�r� �n1�r� Te,.� -1 ln l�l�
(iauge # (�(n C�'l C�SZ to
llate last accuracy tested �2-3--\3
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy