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RPZ_2015_1023 (2)
C�iECK ONE: IRRIGATION DOMESTIC \ FIRELINE BACKFI,OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REpORT NAME OF PWS: CITY OF COPPELL PWS I.D. # ��r�� s�r�-�� �S��� LOCATION OF SERVICE: � � J" � 'On�� �� � � ' The bacl�low przvmtion asscmbly detailed below has beea tested and ma�n a�n� � nq�� �, 'I'NRCC re��ations and is cetified to be operating withia accrptable parameters. TYPE OF ASSEMBLY �, Reduced Pressurc Principle � Pressure Vacuimm Breaker ^ Double Check Valva o Atmosphere Vacuum Breaker i �J Maaufacnaer lIJ I�} Siu I� Model N�ber �d Locatad At SI,�.S�� �J(h� �`'h e��e.Y S►�1� s«��N��a .�G 23�l 5 REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Check Valve Asstmbly lst Check 2nd Checl: Relief Valve Air Inlet Check Valve Inival Test DGClosed Closed Ti� ed at Opeaed at _osid Tight Leal:ed ❑ -5 sid _osid ��S� RP-�-b psi 7 Leal:ed ❑ `` Did not Opea ❑ Leal:ed � �P� and Mataials Usod Test Aftet DC-Closed Closed Tight o Opeaed at Opcaed at _osid Repair Tighi ❑ flsid osid RP sid The above is cerdfied to be true. Firm Name �\ �L�S� Catified Testa\��'���-r+�� (y���tJ��T' Firm AddRss ti�6� �L� (�.�� \\�d�Cert. Taster Na l'1'�(/���� Date lp JZ�i���i Gauge # 0(�JJGS�`� llate last accuracy tested �'�� �`s White- Customer's Copy Yellow - City Copy Pink -Tester's Copy