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2014_1010 C�IECK ONE: IRRIGATION DOMESTIC FIRELINE X� BACI�ZOW PREVENTION ASSEMBLY TES?AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPE�L PWS I.D. # LOCATION OF SERVICE: �`� � (, �,h �� (� �., r �� The bacl�low prevmtion assembly detailed below has beea test�ed aacl maintained as required by TNRCC reaulauons aad is cerdfied to be operating withia acceptable paramcters. TYPE OF ASSEMBLY C Reduced Pressure Principle � Pressure Vacu«Breaktr � _ ,'�. Double Chxk VaIve _ < o Atmosphae Vacuum Bnal:er _ - _ , z_ .,: : ,- .. . _ Maaufactsaer ,��-�� Siu ��, _ Modei Ntimmber Z U�� Located At �l'�\�o C..��ti��r�._� Sezial Ni�ber �}SS l��`1 REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Check Valve Assembly lst Cherk 2ad Checl: Relief Valve Air Inlet Cbeck Valve Inival Test DC•Closed Closed Ti,pht 0' Opened at Open�d at _nsid � Ti�t �' Leal:ed ❑ osid __osid � RP-�.�„psid f� . 1,eal:ed o � Did not Opea O Leal:ed o RePairs and Macerials k� U� � ' r � �� Test After DC-Closed Closod Tight o ppeaed at Opeaod ac _�sid Repair Tight ❑ �sid �,nsid , RP sid The above is catified to be true. Firm Name�e .,,��'�r�� k'"c � Cerdfiod T � �-�o� vJ �^�ad.l s�-_� Firm Address�a X��1�,Q rl�u �`i�X ��;I!t>`> Cert. Testv No.��l�F�2 3 Date �t�- I C�- I�-i (�auge # ��I I N��t��- Date last accuracy tested "�_�'_ �y White - Customer's Copy Yellow - City Copy Pink-Tester's Copy , _ __ . >o