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2014-0620 (9)
„. , .. � . .,. , , C�IECK ONE: LRR.IGATION DOMESTIC � FIRELINE BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPOR? N.�,ME oF Pws: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE:�.S�- � N c}�-c r✓�,� C�f�� I Z t v S �'�c c. u �r�- The bacl�low prevmtion assembly detailod below has beea tested aad maintained as require� bv TNRCC regulauons and is cerdfied to be operating within acceptable paramcters. TYPE OF ASSEMBLY C Reduced Pressurc Principle C Pressura Vacu�Breaker � Double Check VaIve � Amiosphere Vacuum Breal:er Manufact�er �.J G � , Siu Z- Modei Number �'v � /�-� ! Locaud At y�-����,� T�u��'1-, �,•+1 ��1 J� Scriai Nimmbcr �� �'_7 �,� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACWM BREAI�R Double Check Valve Assembly lst Check 2nd Checl: Relief Valve Air Inlet Checic Valve Initial Test DGClosed Z Z osed Ti;ht Opened at Opeaed at nsid Tidit Leal:ed o nsid _nsid RP-_psid �. J �;� p Did not Opea o Leal:ed � �P� aad Materials Usod Test After DC-Closed Closed Tight o Opeaed at Opeae�at �sid Repair Tighi � �sid osid R.P sid The above is catified to be true. - 1 , , `,� � , . � . ,�) r l'� '� � '��.`1 `��k-(i''(r�Od TCSLQ .J `` ��:�� (�,';”r' .,^�.__. Firm Name � � �_::� '� ,'� �r" � � � �� .�p �,,' 3 . . Firm Address � , w. �`��: x �'�% � Cert.Testa No. ��� > � J �+ Date z:Z _r "� .^ -I �; � �::� . . ,� 4 �'j`r'� 1 , � 6,y_ I� h ? .. � .� T Gauge # 4..� d f d !� r/i 4�v � llate last accuracy tested �� - -����'-���� White - Customer's Copy Yellow - City Copy Pink-Tester's Copy _ _ . _ _ _ _ _ __ _ _ _ __