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2014_0729 C�IECK ONE: IRRIGATION DOMESTIC FIRELINE �/� BAC�'LOW PREVENTION ASSEMBLY TEST AND MAINI'ENANCE REPORT x.e►iv�OF Pws: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE: �' a t� 5,�;��-� .-,�-kF �� '� '�e (L '� The bacictlow prcvtntion assembly detailed below has beea tested aad maiatained as required by TNRCC regulauons aad is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY C Reduced Pressiae Principle � Pressure Vacuimm Breaker 2'' Double Check VaIve � Amiosphere Vacuum Breaker Maaufactsaer 1" ��c_� Siu ���1 �I Model Number �G � y� Located At 1�.)�.F� '�:w:�e� , ;� i=�-z�,�- � T- Seria!N�ber F-M C;C+�Lc 4� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Check v alve Assembly lst Check 2nd Checl: Relief Valve Air Inlet Check Valve Ininal Test DGClosed Closed Tight -� Optaed at Opeaed at csid .. Ti�t I. 't�. � Leal:ed � o _nsid _osid � ! ,',� ��. R.P-_,psid i � -�� �;� p Did not Opea O Lealced � �P� and , _ Materials Usod Test After DC•Closed Closod Tight o Opeaed at Opeae�at �sid Rtpair Tight � �sid nsid RP sid 'The above is cerdfied to be t�ve. Ficm Naa�t�l�'e� I �`��?� .��P r,��r�� Cerufiod Testc /r�� � �c�.�,.,;����r x �, (�5'l � �-'a.r� �t,�.�s��`I�1. . > ��� ��um Adclress�_�K`�-�. �'"x 71�,t�E k, Cat Testef NO,:C�t`��r�vJ..��'Y.�'` Da�ce � � �`�`� `�_ (�auge # r�? o i� `?d-�{ 5�� llate last accuracy tested L: � � !y White- Customer's Copy Yellow -City Copy Pink-Tester's Copy . , � ;�.a�, .�as.. -. ..;a� ? '-2� -.�. ._ , '�� ,rc. .d..,w. �t.r��,r . . .r . .-+�k.t�u�- -�+n+�s� _ .�."u- . . . .. . ,_ . ... .... . =ww'�s,. l4r.:.,,. ,. . �C° , ... . _. ._. . . - _ ��� C�IBCK ONE: IR.RIGATION DOMESTIC FIRELINE `�-'' ,� � BACI�'LOW PREVENTIDN AS3EMBI.Y TEST AND MAINTENANCE REPURT NaME oF Pws: CITY OF COPPELL PWS I.D.# LOCATION OF SERVICE: ?��� t�-� �,},���y I--�K� �yE�` �.aO,De I� �T,( � The bac�low prevention assembly detailed below has beea tested aad maintained as reqnired by TNRCC regulauons and is certified to be operating withia acceptable paramcters. . - , : � .. ;T'YR�OF ASS�IviHLY : .� � C Reduced Pressure Principle C Pressure Vacuum Breaker � m� Double Check Valve o Amoosphere Vacuum Breaker >��._� '' Manufactsaer C=�_ �.- Sizc >' Modei Number �` %(..�' Locatod At ,�1 c,v ('-c��=r,1 g.k i;•� V���� �T Serial Nimmber F [��S��:�� J 1 I_'� � � � � REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSiJRE VACUUM BREAI�R Doabie Check Valve Assembly lst C3eck 2nd Checl: Relief Valve Air Inlet Check Valve Iaitial Test DGClosed�? Closed Ti,�ht Opeaed at Opeaed at _osid Ti�t� . Z' Leal:ed�. '� o nsid �sid � R.P-_psid � r•��� Leal:ed ❑ Did aoi Opea O Leal►ed J RePairs and , _ . �. . -� . . . _ . .� . . ; . _ , : ._ � _ ,._ , . . , .. , . . .: R .'. . ,- .. � � Mataials _ � Usod Test Ai3et DC-Closed Closod?ight o Opeaed at ppea�at __osid Repair Tighi o �sid _osid RP sid The above is certified to be true. � __, � / , Firm Name-?.,r(s'� � F,,���,�,a�c.�,,�,� Catifiad Te.4ta � c". ��•�������-�-�� � � � �.�f 1 � l' r ,i i' �c.'4�"`.c`� j't'!' ��t�� � �� � � � � � F��r-�;:r=� �.��t,�.��. --,-.� ��r{ � c�. r�rxo.�;���,�s'�ys a� ? �� � ,�. . . .. � � � . . . � . � � - . 4 (iatlge # �''._?t G1 cl� 1 llate last accuracy tested ,', z /� White- Customer's Copy Yellow - City Copy Pink-Tester's Copy