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2015_0427 C�iBCK ONE: IRRIGATION DOMESTIC FIRELINE B�CKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT ' . , . . . . . . , � .. . � ' � . 8 Na►1�OF PwS: CITY OF CQPPELL � PWS I.A# : LOCATION OF SERVICE: �✓.7SS� �',a�f��� �- /,r l�r;or!`� 7`.a' 7�fS;/ � Tbe bacl�low preveation assembly detailed below has beea tested aad maintained as required by TNRCC re_�ulations aad is cerdfied to be operating within acceptable paramcters. TYPE OF ASSEMBLY � Reduced Pressure Principle ❑ Pressure Vacu�Breaker � , �. _ , ,.... Droubi�+G-h�ek Va�� , � .r } ,. , o���mosphe�e Vac .w�B�eaker , T � t. . , Maaufactiaer 1.r/��f Siu .,��`f �� Model Number �G'7�J/ Locaud At ,�i�/ ��l,�-r� �;1 l,�1.��,c. v:or.�t'� Serial Nimmber G��i�l r REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V�CUUM BREAKER . Donble C3erk Valve Assembly ' � 1st C�eck 2nd Checl: Relief Valve Air Inlet Checic Valve Initial Test DGClosed losed Tight , Qpened at Opened at �sid ' %_v7�-�� Ti�t Leal:ed ❑ ,�csid _�sid R.P-�sid j,�j�� ❑ �s � D1d IIOL�CII ❑ j.C3�►Cd O "rY31f5 � Mataials � }} .:. : . ' �...:., u��.�- ,� ';:-r.. �..�,. �:..�, i �:. .�� . ,. _�� _�.�:.�„'-e 4_�.�`°i i��- ,".' � } ��,�:� .� . � ... . � i . ,:...� . . . .. .� . .� .. �. . . , . .,..'�. .., � . � ... ,. ,. �:.,. ,.,:kq. Test After DC-Closed Closed Tight o ppeaed at Opeaed at �sid Repair Tight o �sid __osid RP sid The above is certifiod w be true. Firm Name,i�'/�1`rrr,�i�r �'io�����,� Catifiod Testa,�r1��� �oGs-���,� r � � � . . . � � . .� Firm Addre.ss / � � .y,� ' Cat Testa No..,�%'Pa���s�yr Date %-��7/�" !` `,��'L.�?r :?.�' 75'.x^� 7 < Gauge # ��/�`%/�_.�.2 ,v Date last accuracy tested /� /�/y White- Customer's Copy Yellow - City Copy Pink-Tester's Copy ... . . . . . . . .. ..... .. . y.... .. C�IECH ONE: IR1tI�ATION DOMESTIC FIRELINE � A BACI�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE RE�ORT � . , � , �� �, N,�ME OF Pws: CITY OF COPPELL ,� 4� .. � .. �� . � . .i . ; . . � . . � . . . . ;'�. . . . . . . � . . . . . . . . � ... . � � _ , � . .PVF�S I.D.# � . .. . . . . . � . -.F: 'G'. , LOCATION OF SERWICE: %',,�-�..��,�,��i��� �'r�t�'�, .�y�`( l�' ,�,C��,s'/ The bacl�flow prevmtion assembly detailod below has beea tested aad main a�r� � nq� � '�CC regulanons aad is certified to be operating within acceptable paramcters. TYPE OF ASSEMBLY c Reduced Pressure Principle ❑ - - Pmsure Vacutmi Breaker :� Double Check Valve ❑ Atmosphere Vacuum Breaker Manufact�er (.rJ,��1 Siu //.:� '� Model Number �i ti' `� Located At /L�w C'!�/s.'i Cr b"�` ���e�`/' 1/.�t,/f� Scrial N�ber f/7 3�'/ REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSiJRE VACUUM BREAI�R Doubie Check v alve Assembly lst Check 'nd Checi: Relief valve Air Inlet Check Valve Ininal Test DGClosed Closed Ti�t Opened at Opened at osid ���f�r Ti�t Lcal:ed ❑ osid __nsid R.P-�psid I,eal;ed ❑ °�' � Did aot Opea o Leal:ed ❑ RePairs and Materials Usod � Test Af�r DC-Closed Closed Tight o Opened at Opeaed at __nsid Repair Tight o osid _nsid RP sid The above is certified to be trve. ..%" Fum Name��¢ia�iir /�i��r�,�,i�.�' Certifiod Teste..L1.•s��s'�sf��ar,�,�^�' Firm Add�+ess //�c/�,���,�-�.�.1 Cert Tester No.��Uo�3�1 H.� Date %'�0?7-!�� ������ � ���� Gauge # /G��i',G/_S^.3•2 llate last accuracy tested /C/�� /� White- Customer's Copy Yellow - City Copy Pink-Tester's Copy