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2015_0204
C�IECK ONE: IRRIGATION DOMESTIC "� FIRELINE BACIQ�'LOW PREVENTION ASSEMBLY TEST AND MAIIV'I'ENANCE REPORT rrq�OF Pws: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE: CS3�J I ��'7�,t����.0�'��`"�'�'v`1 �I,�� . The bacl��low preveation asscmbly detaile� below has beea tested and maintained as required by TNRCC regulauons and is cerdfied to be operating within acr.eptable parameters. TYPE OF ASSEMBLY e,., Reduced Pressure Principle C Pmsvre Vacu�Breakez :� Double Check VaIve ❑ Atmosphere Vacuum Breaker �+ ' Maaufact�er '1I� f'�� �" °� Siu � � ���.� Model Ivumber ����J�N� 4 C� Located At ��"�1`1�" ���:t1 v 1� i���_�Y�r�f;e�.s C..�)r",G;�t=�'{-, �: 1�/G� . Seriai N�ber ��� [� � � �� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER Double Check Valv�Assembly lst C3eck 2nd Checl: Relief Valve Air Inlet Checic Valve Initial Test DC-Closed Closed Ti,,P.ht Opeaed at Opened at _csid Ti,�ht Lcal:ed : ❑ nsid _osid RP-_psid I,�;� o Did not Opea o L,eal:ed � �P� and Materials Used Test ARer DC-Closed Closed Tight o Opeaed at Opea�at �sid Repair Tight o nsid osid RP sid The above is certifiod to be tcue. �; Firm Name�� ;�,�dn �1���-����fzr.�.>S 1'�-_ Certified Testa � `i'�.v E'�'i ����� Firm Address r��� �(��''-1 � -�Y� Cert.Tester No.���' ,. A� �� Date � _ �j -�� �W��?Vr1 ����X . ir;f�-t Gauge # �::)� 1�3� �..:����. Date Isst accuracy tested � - ��(�-� p � White- Customer's Copy Yellow - City Copy Pink-Tester's Copy _ _ . _ _ _ _ __ _ _ i