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2014_1023 C�IECK ONE: IRRIGATION � DOMESTIC FIRELINE i . �ACI�LOW PRE�ENTION ASSF.IV�BLY TE$T AND 11�AIIVTENANCE REPORT � NAME OF PWS: CITY OF COPI'ELL �'!�1.� ,��1;� � I �� PWS I.D.# LOCATION OF SERV�� `�wr 5�-�-� �7Ly�- The bacl�low prevtation assembly detailed below has beea tested aad maintained as required by TNRCC regulations and is certified to be operating withia acceptable parameters. TYPE OF ASSEMBLY c Reduced Pressure Priaciple ❑ Pressure Vacuimm Breaker _< �Q' Double Check VaIve o Amiosphere`lacuum Bnaker Maaufactsaer �l�l 1� S� ,o Modei Ivumber �1�1 (� Locaud At " 2- �°1 ��`� . Serial Ni�ber 4" �j`�n1 � I�EDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V�CUUM BREAI�R Double Check Valve Assembly lst Check 2nd Checl: Relief Valve Air ldet Check Valve 1 Inidal Test DGClosed Closed Tight �d Opeaed at Opened at _,_nsid � Ti�t � Leal:ed ❑ �sid _osid ��r� R.P-�.psid a. � � ❑ Did not Opea o Leal:ed � RtPairs aad __ Mata�ials _ , Usod Test Aft,et DC-Closed Closed Tight o Opeaed at Opeaed at �sid Repair Tighi o �sid �flsid RP sid � �, The above is catified to be true. � ✓��N r Firm Nam� �C.��t� � ��-i f Ccrrifiod Tesca 'f� � ��( Firm Address 1/Ir11 � ,��X� Cat Teste No. ��'�I a Date �b .a�' c�.. Gauge # ��'��-�� • �.� llate last accuracy tested #� �� White- Customer's Copy Yellow - City Copy Pink-Tester's Copy P � . . I . .. .. . . . . . , . .. � . . .