RPZ_2015_0821 C�IECK ONE: /'�
`n
IRRIGATION DOMESTIC FIftELINS
BACI{�Z.OW PREVENTION ASSEIVIBLY TEST AND MAINTENANCE REPOR?
N.�ME oF Pws: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: � � � �'V j �`',�' �� Ui�G� � 1 U
The bacl�low prevention asscmbly detailed below has beea iesied aad ma�n ain� � nq� �, 'I'NRCC
reguladons and is certified to be operating within ac,ceptable parameters.
TYPE OF ASSEMHLY
� Reduced Pressurc Principle ❑ Pressure Vacu�Breaker
^ Double Check Valve � Amno here Vacuum Breaker
Manufact�uer ��(� �� Siu J 2~ i,
Model Number �`��� Located At �'- 5�u r� � Cn'-�-r� ►'1`�t�����i+�
�� � �� ��� i � � �
Serial N�ber
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER
Double Check Valve Assembiy
lst Check 2nd Cbecl: Reiief Valve Air Inlet Check Valve
Iniaal Test DGClosed Closed Ti;ht Opened at Opened at _nsid
Ti�t � Leal:ed o '�,�psid __nsid �
RP•�sid
Leal:ed � Did not Opea o Lealced O
�P�
and
Mataials
Used
Test ARer DC-Closed Closed Tight o Opmed at Opeaod at _�sid
Repair Tight � _nsid _osid
RP sid
The above is cati6od to be we.
; �
Fi:m Name � U G�4 til�, Certifiod Tester � ���C.�r' C+�� t � ('.i r_I'"1 i �_
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Firm Address ���` `� � �}����r ��l'�� I��� Cat T�stc No. �`)4'�I�-���� Date i��'"� I- 1�
�. � ... . '.1 �j r�4 t�iL.��
//-�('l� /r.' f_;` ,.,� ',_�)
17��� � \,'i_.Y��t�.�-��../ ��'` �� '
�
Date last accuracy tested ��` i 1`� ��
White - Customer's Copy Yellow - City Copy Pink-Tester's Copy �
R
C�IECK ONB: I" ��
IRRIGATION DOMESTIC Y FIRELINE
BACKFLOW PREVENTION ASSEMBLY TEST AND MAIIV'I'ENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
�...�� r�.,_
��„ LOCATION OF SERVICE: � �_) �"C��1i✓ �U^Jz7�-' � UL �
����� The bacl�low preveatioa assembly dctailed below has beea tested and maintained as required by TNRCC
regulacions aad is cerdfied to be operating within acceptable parameters.
TYPE OF ASSEMBLY
� Reduced Pressvre Principle ❑ Pressurc Vacu�Breaker
� Double Check Valve o Amiosp ere Vacuum Breaker
� ��9
Maaufactiaer J�'.S Siu
Model Number ��� Located At IL r�_�-.e � (CC +���L.�1i r�LL
Serial N�ber � ��,�'�
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Double Check Valve Assembly
lst Check 2nd Checl: Relief Valve Air Inl�t Check Valve
Ininal Test DC-Closed Closed Ti;ht 1� ed at Opeaed at _nsid
Tight 4� Leal:ed ❑ �psid _osid
R.P- � � I Dsid
�;� p Did aot Opea O Lealce� O
RrPairs
and
Materials
Used
Test ARer DGClosed Closod Tight o Opeae�at Opmad at _osid
Repair Tight ❑ esid _nsid
RP sid
The above is certifiod to be�ue.
, f -
Firm Name � vG���<�:�1 Certifiod Tester ��� �>�f=,' `���-r � --_� �-` `� �
`�' �1 .,, �.� �� ��� �j��f 2�,..r-ry� ���- Z f- f`l
Firm Address ���� � � �'� `� Cat Tester No. Date
_ .
i' � ., r-��� � —r_.'� 1 ti ,�,E
. ._ �
Gauge # c'_.�. �(��ti`�i(_;; �L�
llate last accuracy tested � + ' � ' ��
White - Customer's Copy Yellow - City Copy Pink-Tester's Copy
C�iECK ONE: � �,.�..
IRRIGATION DOMESTIC � FIRELINB
BACI�LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAI�OF PWS: CITY OF COPPELL
PWS I.D.#
LOCATION OF SERVICE: 1 =-� V V ;� �U,.)Cl ��°�J
The bacl�low preveation assembly decailed beloa has baa tested aad maintained as required b�, TNRCC
regulauons and is ce:tified w be operating withia acceptable paramcters.
/ TYPE OF ASSEMBLY
e� Reduced Pressure Principle e Pressure Vacuimm Breaker
� Double Chcck Valve o Amio here Vacuum Breaker
'}1,� ! �''
Manufactiaer lN� > Siu
Modei Ivumber �--�� Locatod At ����- ��6'r, � 1 C!� �(rL,�v r�.
Scrial N�ber �� � ��l��—
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Double Check Valve Assembly
lst C3eck 2nd Checl: Reiief Valve Air Inlet Check Valve
Inival Test DGClosed � / Closed Ti,Qht Opened at Opened at _esid
Ti�t �` Leal:ed o 3 .S psid _osid
RP- � � sid
Leal:ed o Did not Opea D L,eaked D
RePairs
and
Mataials
Usod
Test After DC-Closed Closed Tight o Opmed at Opmed at esid
��
Repair Tight o _osid _osid
RP sid
The above is cerdfi�d to be true.
; LC t`_t,; �
Firm Name UG\�C�r1 Certifiod Testa � �� �� ., ` �- ;
F�aaaRss �liJ i � ��( .�r ��i� ���� c�. r�xo.�� ���� ,� D� � z� - ►,�,�
�_�C���� I�, l� �1P I", ��Ji-�
Gauge # �'�C',� ���L, ..�,�,�
Date last accuracy tested ` 1 � � `'-- 1�1
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy
_. _ . _ _ . _