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2016_0114 ,. C�iBCK ONE: L�RIGATION DOMESTIC FIRELINE � � �.�"� � � �� BACI�T.OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME O�;�vS: CITY OF COPPELL �� PWS I.D.# LOCATTON OF SERVICE: �TG-l>f�. r- 2� 6 / 01lo r�'�1��o; ,�> �/-. ��/)��i� `J5`°� �_ 3�3� � �' T3e bacl�low preveation asscmbly detailed below has beea tested aad main ain� � nq�� , '�CC ; regulaaons aad is certi5ed to be operating within acctptable paramtters. TYPE OF ASSEMBLY C Reduced Pnssure Principlc ❑ Pmsure Vacuimm Breaker _ .�� _ _ -,� . . __ �""f - i3oub�le Check Valve__._ ._... _. _ p- -- -Amio�phere��a�tn�n`Sre�l:et_. __ _ _ _ __ _ _, . _. .. _._ _ �/ �� Maaufact�er ��"� � � Siu !�" .. ' Modei 2vumber � �' `7�'+.• �'��" Located At J ' � ° "�� '"r v `````�erial Nimiber �`� � s� ' ' _ . o-k� - �' REDUCED PRESSURE PRINCIPLE ASSE1t�LY PRESSURE VACUUM BREAI�R .w'` ` oubie Check Valve Assembly_ lst Check 2nd Checi: 'ef Valve Air Inlet Check Valve , �,. Inival Test DGClosed losed Ti,Pht Opened at Opaaed��'t nsid , �,,.a �-,: Tightf , Leal:ed o �sid __nsid t R�• '�' nsid . Leaked � f� � ,Did nor Opea -�c'�' ''L,eal:e� � , �Pairc "� a � _ _,. ..�,,. �1LCTl�S _ _. , :. _._._._ ._ -- USCd _ Test After DC-Closed Closed Tight o ppeaed at Opeaed at _�sid Repair Tight' ❑ nsid __osid RP sid �. The above,i�s/cectified to be true: if'`°1�' z�-�-�,•., ��-.�i--� 3 ��r �— �� t a—�1'-��U.� � � ,..� Ficm Name Catifiod Testa ��" � � '""� x ' %�r, �- �0`� � V�i� r i , � r- ��- (> ., ,�:, o / � FirmAddrGss Cert. TestQNo.�� °"t �. ! �' � Date ��'``7 _ ✓...~�.r:l r,. l� �^" r4 ;�1.i r • '�'.. A " ti_a 1 /� , `,S � �_ �- i GBuge # � �`'`�'� s'� a llate last accuracy tested J� �� G�� White- Customer's Copy Yellow - City Copy Pink-TesteNs Copy � . . _� � � � , r ` i � ��,. � � ��8: � �• � � � � IART��N_�; DOMESTIC FIRELTNS 3 ,�;��;i{�;,Q�V PREVENT�ON ASSEMBLY TEST AND MAINTENANCE REPORT � �� '•-,�� +,�� ;;` x rx �� E; ,,,� R °� CITY OF COPPELL ; , ; '.i � A �� } � , �p.��,� :�Y � �� , �� La � �� , u <. �,r _ . _ _ a � � � � � � � � .�: ,4�. � � �. � ,/ � ui �� LOCATION.fi3�� ' VICE: S�T��'�� s — 2 �� '►/�.� .t-�-��,,� �.�-�r-�� y� � �vr � r jn �S` I— ��S�� rf , ,, �. / � 1 ' : � �t. The bacl�la�' p�ve.ation asscmbly detailod below h�s beea tested aad maintainCd as required by TNRCC ��uladons amd�s"c�ified to be operating within acceptable parameters. , ' �, � ., l �. ��;� T�'PE��ASSEMBLY ` C Reduced Pressure Principle �`'� Pressure Vacu�Breaker , _� v_- � �,�r?�'.._.>_-�e�bl�-��>��-r��_m� ._.�:«_� .p., �� _�1��ae�o�acmum�Br�aker=-:,.. x, _._--- ..a...>___.s_ M3lttif8C211fGf Y "� � s � S1ZC � rr ` 1 � � �Model`�iumber 7 7�` x � � � � Located At �� ` � " �� fi- --. ._ ., , �.�� Sctial Number �� ?$f`' o z , ��, ,, � ,`� , .�. . P` . t. ��' ' RED�T�ED PRESSURE PRINCIPLE ASSEMBLY PRESSiJR�VACULJM BREAf�R � . t . q�� ,_. : : � � � ,� r�5 ., Doabl�Check Valvt Assembly `"� - , . � � : � .. ��, , .�� _ , . �.;�t . lst Check . 2nd Cberli. � °;,. I�ef Valve Air inlet Check V ' ,,, ; � .� � , x,�• �`� Ini�al�'est DGClosed osed Ti;ht ❑ ed at Opened at �_�d '��= :,� ,F"�;/.�,�� Tight Leal:ed nsid __nsid R.P-�'�"' Dsid ,� . Leal;ed ❑ Did not Opea o L,eal:ed �� ,.� �� f�f,` � : . � ..' . • Mataials _.. � , � , , _ _ ..- - _ . _ _, __ , .,., ��.:.,.. , , , _ .. ,. , � , - �' r,�.� . � � � . . � � . Aftet DC-Closed Closed Tight o Openod at Opeaod at __nsid -- Tight ❑ Dsid _,_,osid RP sid •� � � � . . � o, above is catified to be aue. ` � � ,� -�r,� � l'" -- � k.� ` �� s f�'�,..�.'S-t-�r-+� .f �� r-c:;.; � 1-��fi�v.J � o �. ��"� ��'��,.um Name� Certi�i�d Testcr , ,�3 l�� I � f R � ' µ ,. �� / ��y;.��r, : _Z a /�i , 3 ` Z �trS ` f �-y � �„c� ; F"� , � � � v �� u� CC[t. TCStC[NO./� A O f Z( "�' I ��, /�":. �« � ,_�'4ddKss , er . .� '�.. '� ;�,� � �a��„. �t r ��f ; �-.:�?�,�� 'j`�''u �` Z� �� Y��uge #' .. S"' �`�a �''� � � � ,,, .,.. � ��. � . . . , ; .. � p. Date last accuracy tested ;`Z � �I ' � �� . White- Customer's Copy Yellow - City Copy Pink-Tester's Copy , __.__ur __ _�.�,.;. �_..�._._. . . _ . _.__.__--_�_.. . . _ __.. __ _ _ _ _