2014_1010 C�IECK ONE:
IR.RIGATION DOMESTIC FIRELINE �
BACI�'LOW PREVENTION ASSEMBLY TES?AND MAIIVZ'ENANCE REPORT
NAIv�OF PWS: CITY OF COPPE�L '
PWS I.D. #
LOCATION OF SERVICE: ��}� C.��a,In C�,.�
The bacldlow preveation assembly detailed below has been tested aad maintain� � nq� bv TNRCC
reguladons and is cerd5ed w be operating within acceptable paramcters.
TYPE OF ASSEMBLY
C Reduced Pressure Principle � Pressure Vacu�mm Breaker ,i
� � : '�. >, a Amiosphere Vacuum Breaker .
� _ - - - _
uble h ve G
. �
Maaufacaaer � Siu 1
Model Iv�ber 91�t'� �_ Locaud At �U 1"� C �\`�r,�c��
Serial Ni�ber �'��r;��
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Double Check v alve Assembly
lst Check 2nd Checi: Reiief Valve Air Inlet Check Vaive
Initial Test DGClosed Closed Ti�ht � Opened at Opened at _osid
Ti�t � Leal:ed ❑ �sid _osid
�S�
RP-�sid r 1
Leal:ed ❑ `" ,lr Did not Opca o Lealced J
RePairs
and
Mataials � �
� , U� ,.� � - .�y
a
;
Test Aft,er DC-Closed Closed Tight o Opeaed at Opeoed at nsid '
�
Repair Tight o �sid __nsid �
R.P sid
The above is cerdfiod to be t�ve.
Firm Name r,�rr,r, �'�'�_ ��<=. Certified Testa�
�r�s W• rnoc��^
Fi:m Addc+ess�1r.x�1nn.r 1,� c `T��S�lo S Cert. Testv No. �IS`�23 Date �U-1 �1
Gauge # U�11�-12�,l��
llate last accuracy tested 5,•21 - 1��
White - Customer's Copy Yellow - City Copy Pink-Tester's Copy
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