2014_1024_RPZ C�IECK ONE:
IRRIGATION DOMESTIC ✓ FIRELINE
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINI'ENANCE REPORT
NAN�OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: C� �, �.,n �
The bacl�low prevmtion assembly detailod below has beea tested aad maiatained as required by TNRCC
regulauons and is cerrified to be operating within acceptable parameters.
TYPE OF ASSEMBLY
P'' Reduced Pressure Priaciple ❑ Pressure Vacu�mm Breaker
^ Double Check Valve ❑ Amzosphere Vacuum Breaker
Maaufact�er �A� �1��'_`� Siu �` �
l �1�7C-� �"�
Model Ivi�ber t-"i �� Locatcd At V!1 A�� t�v��� t-�v�R � F-���R��.�'����.✓'
Scrial Ivimmber � � ��� � � R.�,�'►�ro
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V.�CUUM BREAKER
Double Checic Valve Assembly
lst Check 2ad Checl: Reiief Valve Air Inlet Check Valve
Initial Test DC-Closed Closed Ti,pht Opened at Opened at osid
Tight Leal:ed ❑ �psid _nsid
RP-��psid
L,eal:ed o Did not Opca O Leal:ed �
��
aad
Mataials
Used
Test After DGClosed Closad Ti,,p.ht o ppened at Opeaed at _�sid
Repair Tight � Dsid _osid
RP sid
The above is cettifiod to be we.
_
Firm Name'���S�c��AC���:�u 1�r�d • Certifiod Tcsta �'�t1N��1 S�t,�i'�
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Firm Address�'�� � �� , y��Cat TaSta Na l� ��" Date (�-� � �!�-�
�.,.��'�.t?i�t s �-�"��7�;�`��
(�auge # �� (����]��
Date last accuracy tested ,�-�- 1`t
White - Customer's Copy Yellow - City Copy Pink-Tester's Copy