RPZ_2015_0731 C�iECK ONE:
IRAIGATION DOME3TIC v FIRBLINE
BACI�Z.OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPOR?
NAME OF PWS: CITY OF COPPELL
PWS I.D.#
LOCATION OF SERVICE: ��� �rq����C �. c��t;�. IO� '� s o/ 9
The bac1�low preveation assembly detailed below has beea testcd and maintain� � �� �, '�CC
regulations aad is certified to be operating withia acceptable parameters.
TYPE OF ASSEMBLY
Reduced Pressurc Principle C Pressure Vacuimm Breaker
� Double Check Valve ❑ Atmosphere Vacuum Breaker
Manufactiaer
��T�� Siu 3�1{��
Modellvumber 1.FQ�q^�3�T LocatedAt ����+� � w��t' S�o�9��n�C
Serial N�bc ����
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Double Cherk V alve Assembly
lst Check 2nd Checl: 'ef Valve Air Inlet Checic Valve
Inidal Test DGClosed Close�Tight ODFaqd at Opeaed at _nsid
7 31'1 S Ti Leal:ed ❑ o(l nsid nsid
RP�'�Dsid
Pa� Leal:ad � �� � Did no�Opea � L,eal:ed ❑
�P�
and
Maurials
Usod
Test Aiter DC-Closed Closed Tight o Opeaed at Opeaod at _nsid
Repair Tight ❑ nsid __osid
RP sid
The above is catifiod to be true.
FumName���ec�Fbr,r �:� J+�c. CatifiedTester �c��p4leif' �. Co��i�'�ar�
�I Firm Address Q�•�vK ll�A'�ic��o�t�n, Cat Tesw No��(o a.lQ/ Date '�3 I-1 S
' �7'� 7l�OlvS
��, c�a�e # Q�5 I 41'fl!o�'
Date last accuracy tested g—���y
', White-Customer's Copy Yellow - City Copy P1Nc-Testei''s Copy
C�IECH ONE:
IRRIGATION DOMESTIC i/ FIRELINE
BACKF'I.OW PREVENTION ASSEMBLY TES?AND MAINI'ENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS LD.#
LOCATION OF SERVICE: �O g IN'C4II�IP_.C'�C. ���P, I'� 0
The bacl�flow prevention assembly detailed below has beea testad aad maintaia�d as require� bv 'INRCC
regulations and is certified to be operating withia acceptable parameeters.
TYPE OF ASSEMBLY
� Reduccd Pressure Priaciple C Pressvre Vacu�Breaker
= Double Check Valve o Atmosphere Vacu�mm Breakec
� ��
Maaufactzaer � S Siu I �a-
Model Ivimiber ��0�/�'�QT Located At c,Jq��1o+�� � wq��fio v4e ��r(
S«ial Nimmbcr � i � ��3
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Doubie Check Valve Assembly
lst Check 2nd Checl: 'ef Valve Air Iniet Check Va1ve
Iaiaal Tat DC-Closed Closed Ti;ht at Opeaed at _esid
?31—{5 Ti� Leak.ed � sid _nsid
R.P-�isid r� T
�C.15'"j Leal:ed o ! •� Did not Opea ❑ Leal:ed �
�P�
aad
Maurials
Used
Test ARer DC-Closed Closed Tight O Opeaed at Opmed at nsid
Repair Tig�i ❑ nsid osid
RP sid
Tl�e above is cenified to be true.
,, Firm Name ff II;�FIo��J �t�'�I�� �c.. Certified Testa (��_���u' �—• �✓►1q�
Firm Address��`�wc I I 50!�����n� Cat T�ster Na� �I�O�(o I D� �31—I S
' TX 7�D�S
c�auge # 05141 D (o�
' Date last accuracy tested — b�/
White-Cu4tomer's Copy Yellow - City Copy Pink-Tester's Copy