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RPZ_2015_0226 CI�IECK t�N�: IR1tI��'1'TION DaMEST'I� I�IIiBI,T�I� ✓ �iAC`KFLt�W PREVENTIfJN e�►SS1�Y.Y T�T AND M�!►iNTENANC"�REPt)RT NAME 0�`PWS: CIT`�'t�� CU�'PELZ, PW5 I.D. # Valtey Rar7cli Baptist Ct�urch LC��ATION t7�`SE�VI�E: ��oz �e�F�����An r;G���u ���o� � The bac�low prevs;ntioa assembly d�tailed belw�v h�s bem �ttd an�i mainrai�rd as rtqui�td bv T1�RCC re„Qulations�is c�rtifie�to be op�ratin�vvithia acuptab�p . 'T`YP�C��'ASS�vIDLY � R�duc�d�'ressu�P'rin�iple � l�ssure Va+�n�n Breake� � Iyo�xbl�Chexk Vatv� Q Araiusptt�re Va�u�m B� � . a �, ��� w� 1�� n.�S �� � M��r��«- '?5 �a�� �,L, CG,n.�.�� s«z�r�,.��a �dh�c�i�'3 . REDUCET�PRESSLTR�P'ItI�V`�LE�SSEMBtY PRESSURE V��ULTM BREAKETt Do�uble C`�eck 4 alve Assea�bly 1st Chtclt Znd C�reck R�Iief V'�Ive Air Inlet t�etk Valve Initi�l Test DC-Cl�se� Closrci 1"i�h� � Up�a�ci at - C��at ��Tnsid 1i�t � Leal:ed C7 ��id � ,�n�id c�SS Rp., G-,�.p�d � , (,P Lta�nd n -�'� Dir�not Opm o Lr,akod a � , and� � • >>��► .�, o M�tetiais " Useci Tcst ARer D�-Clos� Cita�rr#?ight � Opened�t Opmad at tisid ,.�.�...� R�pait T'ig�t a ,�.�,_,__„vsid ,_,,�,�sid RP `d The a�va is�e�i5r�ta bc trta�. Fsrm Na�e l��s�r r�P�1�'t Yt4 �� �,, /� Fi�rm Addrtt� ' C+art. Testar 1Vo. Da#� �� e+F 1(�IZ.� ��w�+� � __C�leDZ4 '1� llate Last accuu•acy tested ►��3` �� White-Cu�rtamer's �y Y�llow - City Co�rry Pin1r-Tester's GcFy C�IECK CJ►NE: IR,RIGATION DC�MEST`l� PIR�LIN� BACKFLOW PREYENNITCJN A55ElV�LY T�S?.�1VLCr�uNTLNA�ICE REPC)RT NA�0�"PWS: C1TY t�� C��PE�L PWS I,D. # Valley Ranch Bapt;st C17urch LC}CATI�N Of SERV�CE: �50� ���i►���,r��aa c,�,�p��� ���an "1"'�e bar.}�]r�w pr�vtariaun assembly detailnd tretow has bcm � and mais�tas�ed as r,� brr TNRCC �,evlatior�s�rnad is�cd u►bt opa-atiag�ithiri arcr.rptabl�p . 7'YPE t3F AS�ENI�LY ,� R�du�zd Pr�ssa�e P�incipie � Pr�ssurc"Vacurs�a Breaker � Da�ble�heck Vaive a Amnc�sphe�Vacuum Br� n����� j��5 s� ah�� Madel Pitattbcr "I 0� Lacatad a�t I�I.QC� � l:- �l�� , , S�rial N�aab�r I ��d� � REDUC;ED P�tESSURE PRRI`NN�"LE A�SSEMBtY PRES5'URE V��BREAICER Uo�uble C7:eck 4 alve Assar�bly lst C�etk Zad ��c�l: 1te,li�ef Yalve Aer L�let G'6ersc V�ve lainal7est �1C-Claseti Closai Tight t� at C�arxl at _____,_„asid Tight o Lt�xd O sid _,,;�__�__„p�id �� � RP-,��'�,�flsid (p. �i�n �O�rt L.ea�;rrl � Z Gitd not 4�en c� I.ealc�d o �� ����5 �.c�/ �'Q�l' lr-UG'�* Ma� - u� Te�t�r 17�•Closr� Ciosod Tight t� C�aed at C}pm�al�t nsid � Re�pair Ti�tt o �,"nsid `,�,��sid RP' 'd T'he above is c�5s�d to'be uv,e. Fitm N3m�1�'r r#�-C?o►�Y1�S�,r t�'�`Lf°LS� ��'I' ��-- �/�,� Firm�ddre�s �° Ct�t. T�stitr No. Date ' e� 1 t�rZ� �auge � _C�LQD�4 J'l(o llate last accwracy test�d�r3` �� White —Customer's �y Yellow —City CopY Pink—Tester's CoPY G��ECK t�NE: IA'.RTG�II'I`IUN DOMESTI� __ �'I�'L�LTNL � ��►ra�nw r�v�rrrY�x Ass�t��r r�sr�nm�rs�►nv�r�x�rrc��Rr NAI►�oF'P'c�r'S: C1TY OF CUPP��L pWS I,A� Valley Rancf7 Baptist C����rc17 LOGATIDT+J O�`SER.VICE: ��a, ���it��r,�:���cQ,����� i5�o�� Thc bar.�low prstvmtioa asscmbly detailed bclow has bten tested a�d maintai�ed as r� brr 1NRCC rt�,�ians�ad is�ficd tt�be�p�rating wit�ic ac�eptabl�p�. 1"YPE OF ASS�M'HLY /� Rtdurzd Pnessure�iple � Pr�ssurc Va�cuumn Breaktr � I�uble�heck Va1ve � Atmasph�VaCu�nn B� . � i� ManufaGcaa�r ► Size .Mad�!N�mber "l 1 S L,r�car�eci Ac S• LU.n a►0 "I ._�.. Se�ial Nurnber GUU ��Pf$� � RE�UCED P�tESSURE PRnV�'�,�,A�SEMBLY PRES5IIRE V 4�"ULTM BR�AKER Dnuble Check Y alve Asseambly 3st C�eck Zad Chec1: R�1eef''�alve A►ir Inlet C�ee�ekk Vtel�ve Iaicaj�2�t DC-Cl�sai Closcr�7ig,ht 4p�at (�tar,d�ct nsid "1 Ti�t � Le�kai C� ��osid • osid �'�_ � �,-....�- R�'• 7 b_„��id I.��d � (,.8 1)id noc ope� o t�aked C1 �� and Mat�erials ' Usa3 7e�t� I3C-�lns�� CZ�i 1i�ht � C7��at (3pmod at nsid R�pair 7ight ❑ �,,,��id �_,��sid �' RP id ?he abavt is ca�i6ai w be true. Fina Nas�e 1 t�Fi�-e�-Ue r,�t�,r T��rt9 �?est�c' � �'irrm Ad�dc�s i�D�6)c�SZ(Q��v' r ��rt. T�t,or No. I3ate s_L�/� e� �1t�IZ� ���� � _�leD�oS'1t� llgte lsst arcuracy te�ted���' � 'T White - Custflmer's Cz�py "S�"ellow - City Ca�y Pink-Tester's LooPy