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2015_0226 (4) C�IECK ONE: IR.ItIGATION DOMESTIC FIRELINE � BACI4'LOW PREVENTION ASSEMBLY TES'T AND MAINTENANCE REPORT NAIME OF PWS: CITY OF COPPELL PWS I.D.# Valley Ranch Baptist Church LOCATION OF SERVICE: 15oi E aenr�e Ra coppeu �51os � 'I��e baci�low prevendoa assembly derailed below has bem tested aad maintaiaed as required bv TNRCC regulations aad is catified to be operating withia acceptable parameGers. TYPE OF ASSEMBLY ❑ Reduc,ed Prossure Priaciple e Pressure Vacu�Breaker ,� Double Chcck Valve o Am�asphere Vacuum Brealcer Manufacnaer �Q� Siu �S Modei Iv umber �1�" X Locat�d At IU � l'�I'��r (h VR�-Q�" Serial N�mmber � b d I 42 REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUTIM BREAI�R Doubie Check 4 alve Assembly lst C3eck 2nd Cbecl: Rdief Valve Air Inlet Check Vaive Inival Ttst DC-Closed Closed Ti,pht m,' Opeacd at � Opeaed at _nsid � Tight .� Leal:ed ❑ �sid _nsid RP- ��sid �,� Leaked ❑ Did not Open O Leaked O RePairs aad Materials ' Usod Test After DC-Closed Clasod Tight o Opened at Opened at _�sid Repair Tight ❑ �sid _,osid RP sid The above is certifiod to be true. V��t Gl� T Fitm Name 1 la- F�t-f �-Lb�'ieC�cT�S Catified Tester ��•« ,��LL_ , � ,., Fi:m�D G�c �SZI'$ F�t�—I�Ua✓�-GLCert Testc No.k7 �i� Date '� ����i2� Gauge � �Q�10Sr1(P 1�ate iast accuracy testec� {2.'3 •�� White- Customer's Copy Yellow - City Copy PiNc-TesteNs Copy C�IECK ONE: IR.1tIGATION DOMESTiC FIRELINE ✓ BACT{FLOW PREYENTION ASSEMBLY TES'T AND MAINTENANCE REPORT NAI�II:OF PWS: CITY OF COPPELL PWS I.D. # Valley Ranch Baptist Church j,OC,4,"r'jQj1�F$��CE: 1501 E Beltline Rd Coppelt 75109 The bacl�low preveation assembly detailod below has been tested and maintaiaed as requind bv TNRCC regularions and is certificd to be operadag withia acceptabie parametets. TYPE OF ASSEMBLY ❑ Reduced Prassure Priaciple e Pressurc Vacui�Breaker � Double Check Valve ❑ Atmosphac Vacuum Breaker Manufactiaer �A.)� Siu 3/ � Model Number (1�^l � � Locared At /U� Corn Prt� 1 h VR�.�� s«;�t rr�va s o lo a� � REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Check v alve Assembly lst C3eck 2nd Cbecl: RdKf Valve Air Inlet Check Va1ve Iniu Test DC-Closed Close�Tight Opeaed at � Opened at �sid !� Tight ,}SC Leal►ed o �nsid __nsid RP- �ig ,psid Leaked o ��� Did nat Open o Leal►ed o RePairs and Matrriats ' Usod Test After DC-Closed Closod Tight o Opeaed at Opened at nsid _� Repair Tight a �d ,�_osid RP sid The above is ce�tified to be true. Fiim Namel I�tFi r-e�-►�o►�r�'S�-►r T�1�YlQ Cectified Testet ' Fi:m Addr+ess ir Cat Tester No. �b � 8 Date_ e-u 1c�12� Gauge # l�l.eDZb�'?�o Date ]est acceiracy tested �3' � White - Customer's Copy Yellow - City Copy PiNc-Tester's Copy ���g�� ���: � LRRIGATIO�I 17►flME�''IriC PIR�3I,TI�`� BA�W PREV�NI'IQN A�5EM�LY'TES?ANb MAINI`ENAN"CE REPC)RT r��.�rE oF PwS: �IT�'C3� C���ELL pW$ I,rj, � Valley Ranch Baptist Church L,aGATI(7N O�SERVICE: ��a, �r��t������a c������ 7��oa 'I'he tsac3;flow pr�veatiaa assc�l�ly det�ilt� belaw bu�s 6ce� �t� aad �taiutd as r,cquired b�v 'TNRCC re„eulations�+d is�c�to bo op�x�ating withia accr.pt�ble p�ne�:s. "�'YPE Ol�a�5'S�+[8LY c Rtrlur�d Pr+essvre Pr�iuciple �' Press�r�Vacurmn Breaker �2' L�ouble�heck Vaivt c 14,m�vsplxrnt Vac�u�m klreaka Mamrfact�rer _,y�,�� 5izc � ���N�� �� m l �A� N .�td P _o� ��,� s�t rr��«� 13°I D REDUC:ED PRESSUI7,�PRIN+�`L.E ASSEMBLY PRESSIJRrE V 4CUZTM BR'�LAILER Do�uble C3eck Vaive Auambly lst(�e�ckk �nd C�eck Rtlief"���ve A�ir Inlet t�eek Va�1vt Iaiaal?est DC�l�s�ci Clasec�Ti�tit t�pCtt�d at C}ptinad at �� �,r7 ?i�tt Leal:ad ,�n�id �sid �1/ Rp._„�psid I..eal�! o (`� Did aat Opea � Le�ked C� �� aad Materials " Us�i Test ASer DC-Clasr� Cxcsed Tight fl Qpe�ta!�t dpm�d�t _.,�„��nsid R�pais Ti�ht o �,,___,_.,,.��sici ��_��rsid RP id The ab�ve is cer�i6ed so be tnae. Firaa Na�l�`�-C����,r�� r°LQ �trtifi+cd 7 Firm� C�rt. Trstc N�. ]�at�a e-1t' �1(�iZ� c��� � l�le D�b�rl S� I)fl�+2 .�HS� &CCW'f1Cy" tP.S��tj ,�'��` �� ww��- custo�,�,��s r.,�y ��uow -c;ty �y Pink-Tester's CoPY C�tECK I�I�L�: IRRI�t�TION UOMESTl� PIR�LIN� BAC�ZOW PRE'V�1+�"T�t�IY e�SEN1�LY'TES?ANI�►MAuNiTTEENA►NG'�REP'�RT NA�M�t�f�''UV�: �17'Y t�'� �'�l'�'E�L PWS I,I7. # Valle Rar�ch Baptist Churc}i LC7CA�TION OF SE�t.VTCE: ��a, �e��Fr���,� F�c�c����u !�,a� 'Tht baci�iow pr�vmrion assembly d�ed bclor+v has bem �xi an�i mairnrair�rd as required by TNRCC �¢ulaaans and is certifiai to�operatiag�vith�acc�prabl�p�s. "T'YPE t�T`ASSL'MHLY e �educ.ed�'ressvre�le e Pressrsrc Vacunmo B� � Dauble�h�Valva � Amcasphcre Vacuum Brr.�er t������ s� S� ' Maicl N�attber 17�C�—(— _ Lvcatod At I V1 w_.VQ,�kX' N� Cw'►'�� , ��N,��� a� 0 33� i REDUCE�P�ESSURE PRI'NCIPLE A�SEhlB,LY �'RESSI)'RE V 4�'UUM��R Doubie C3�eck�+aive t�t�mbly lst G7�e�1r Zad Checl: Reli�ef V�lvr A►ir Inlet +C�er�c Valve 17niaal ? DC-�lnsai Closez�"I`i�ht � Qpe�ed at Upea�at _,_,__�_�_,osid Ti�t � L�.td .� �sid _'�,,,..,,nsid �� RP-�sid Leal�d Did nat t7pan t� L,eakad ❑ �� aad Mat�rials ' Us� Test A.�cr DC-Clos� Clc�d"I"ight o Opc�ed at C�pmad at ,�nsid R�p�ir Tight ❑ �,ns� �sid It,P `d 'I'!�e abrrvc is ccti6ai ta�c truc. ��Nl� Y D�V l �— Firm�Na�t1�r-►r�e`G-C�et�r�S�r T�rt9 �7 � � ..._.___. Firm�►ddn�t�Q� Ctrt. Trs�r 1�Io. � ^��5� Da�tc � � e1t -1(�IZ�t c�� � nl�DZa�'1S� llste l�t eccurscy test+�d 1�r�` �� White - Cu�tomer's Cdpy Yellnw - Cit,�' CaPY Pink-Testet�'� CoPY CIIEGK t�NE: I�tRIG.�TIUN UUI�lE�TiC PIR�LINE� B�c�t.,�ow��v�r�n�►x�s�Lx r�s�r�r�au��rrc��oRr NAM� 4F PWS: C1TY f�F C�7P�'�L,L pW� I,j'�. #� Valley RancM Baptist CI���re17 L{)�CATIt7N'�F SEI�.VICE: �5a, ��������t;aa c�;���u 35���� Tht bar.i�tr+w pr�vmticm assem�ly d�iltd btiow has besc► t�sted aztti m�i�ttai�td as �quirod bv 7NRCC regulanions�nd is�ad w be oparating witliia ac�cprablt p�s. TYP���`ASSEMBLY c Raiucr,�Pr�essvre Priaciple � Pressurr�Va+cuKam Brr.ak�er � Dauble�`hecl�Vatve o Am�c�sptrcne Vacuuim Brcal:� Manufacaa�r e �iu 3�� ���r���� �OG �,�t � w � Ca��Y �f.� Vc�u.Q�4-- , , s�t ra��a 1.�,��� REDUCED PRESSURE PRIN�LE ASSEMBLY PRESSURE V�4�iJtPM BR�It Double Check ti�ve Assmbly ls�t Cht�3c Z�td C�eck Rrlief Va�lve Aer In1et t�aee�tkk'V�,Ive Iaiaa!T DC-Closad �losed Tight � �at O�a�at „nsisi , Ti�s d Lra�:�d J� _.�..�.�sid �nsid QI� R�'-._._.._pszd i � 1 ' � �- Did not Upen � L,eakod o �P� and �1+i�u�iats ' Used Test A�er DC-Closed Glased Yight � ppe�ed at C�pmnd�t ��sid Repaur ?��ht d ,_,�„trsid �naid RP id The ab�rve is cc�t�i w bt tnu. Fitm NamEe 11�Fi r-e�-C�o�5�,r���f't� Crt�ified Teatar ��� Fixm Addr�s , r„� Ctrt. Te�ttr N+�,��D+ste � ,� �1[ -1(�I�,Ct ��� � nleD�6�'1b ll�t� la�t$ccuracy tested �"�'"�' l� White - �ustumer's Ccr�y Yellow -City Capy Pink-Test�r's CoFY