RPZ_2016_0208 C�IECK ONE:
IRRIGATION DOMESTIC FIRELINE
BACKFLOW PREVENTION ASSEMBLY TEST AND MAIIVTENANCE REPOR?
NAME OF PWS: CITY OF COPPELL
PWS I.D.# z� ���'�,r►�� ��-
LOCATION OF SERVICE: �Q'� ����'�`�'��C.
The bacl�-flow prevmtion assembly derailod below has beea tested aad maiatained as required by TNRCC
regulations and is certified to be operating withia acceptable paramcters.
TYPE OF ASSEMBLY
Reduced Pressure Principle � Pressur�Vacuimi Break�er
❑ Double Chxk Valve o Amnosphere Vacuum Breaker
t-' �i
Maaufactzaer W 1� Siu �
Model Number L r-g�� Located At �nl�C��10�5���i��¢, �+n�CS
Serial Nimmber � � �J�'�
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER
Doubie Check v alve Assembly
lst Check 2nd Cbec1: 'ef Valve Air Inlet Check Valve
Inival Test DGClosed Closed Tight Opeaed at Opeaed at _osid
a-4�- ��' Tight Leal:ed ��� o e/•I psid _osid
RP-�psid
Q�SS Leal:ed ❑ Did not Open o Leal:ed � �
�P�
and
Mataials
Used
Test Aft�s DC-Closed Closed Ti,,Q,ht o ppeaed at Opeaod at _�sid
Repair Tight ❑ �sid �sid
RP sid
The above is catifiod to be true.
�- , � �
Firm Name � i�F����'���'+I���C• CertiSed Tester L.��;���l��• (:��r►1�(n
FirmAddress��xrl�'J��c�'��u�t,'TIC`7(�;1�5 Cert. TesterNo.���'�� Date �����
Gauge # �J�1�/I���.3
llate last accuracy tested �"���- ��
White - Customer's Copy Yellow - City Copy Pink-Tester's Copy
C�IECK ONE:
IRRIGATION DOMESTIC `� FIRELINE
BACI�'LOW PREYENTION ASSEMBLY TEST AND MAINT'ENANCE REppRT
NAME OF PWS: CITY OF COPPELL
PWS I.D. # � .� �i1��yvt,u� �� .
LOCATIOIv'OF SERVICE: _ �� � � �`l��-�I�.�'��
.
U
T3e bacl�low preveation asscmbly detailed below has bxn tested aad maintain� � n�� �, '�CC
regulations aad is ccrdfied to be operating within acceptablc parameters.
� TYPE OF ASSEMBLY
Reduced Pressurc Principle ❑ Pressure Vacu�Breaker
^ Double Chcck Valve o Atmosphere Vacuum Breaker
Manufactiaer 1n�'�1��' Siu ��y�i
Model Number �F�O���3 F�� Locatad At in!�s��.`x= (� �c�'qq��/!�C�
Scrial Ni�bcr ����t'i
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Double Check v alve Assembly
lst Check 2nd Checi: Reiief Valve Air Inlet Ci�ecic Va1ve
Inival Test DC-Closed Close�Ti,Pht ❑ Opened at Opened at esid
a'$-I la Tighi ❑ Leal:ed ❑ nsid _�nsid �
RP-_psid
�a� � Leal:ed ❑ 1�`,k;�'� Did noc opea o I.eaked �
�� C'I�e.r=;�ed �-�-
� �1��h�� ��-
Mataials
Used (�.,�e� i
Test DGClosed �losed Tight 0pea}ed at Opeaed at �sid
Rep ' a Tight (�` � �� �sid _osid
RP �� sid
The above is certified to be true.
Firm Name��iC',�;�o� �f�c+���;-�i-�.�ilC• Cettifiod Testet �f i S�pl�P.f�,• (�/►'(A Ml,
_Y
Firm Addres.s Q����1��`D J�i d��w�.T)C`7�5Cert. Te.ster No.f4Q0 fl l f��Lt C Date '.�g l�0
Gauge # ��%�/���
Date last accuracy tested �1'oL-15
White - Customer's Copy Yellow - City Copy Pink-Tester's Copy