RPZ_2015_1026 C�IECK �NE:
IR.RIGATION DOMESTIC FIRELINE
BACIQ�Z.OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. # ��t�}
LOCATION OF SERVICE: ���� �'�I���5� ��-���`�
The bacl�low prcvcation asscmbly detailed below has beea tested aad IDaintain� � nq�� bv TNRCC
reguladons aad is certified to be operadng withia acceptable paramcters.
/ TYPE OF ASSEMBLY
l�� Rcduccd Pnssur�Principlc c Pressure Vacu�Breaker
� Double Check Valve o Amaosphere Vacuum Breaker
Maaufactiaer ����C`iN� Siu _��f
Model Number �7 s Located At �t:S�` /��o/jl.
Scrial Nimmbcr L�� ��
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Double Check Valve Assembly
lst Check 'nd Checl: Relief Valve Air Inlet Check Valve
Ininal Test DGClosed Closed Tight Optaed at Opened at �id
Tighi Leal:ed ❑ �sid _nsid
�°'SS RP- 7� sid ��s1
�;� o Did not Opea o Leaked �
�P�
and
Mataials
Used
Test Aft,et DC-Closed Closed Tight o Opeaed at Opeaed at �sid
Repair Tighi ❑ �sid osid
RP sid
T'he above is cerdfiod to be true. �I�i
Firm Name � �i�`�°(o�a!^.L,.��IC, Certified Testa „� �,c.�r,r,(!/G �
Firm Address�/�Oe7 ��i'On�l ��tLP Cert. Tester No. O �� ? Date a"��
cauge # 4�D`��'1$7
Date last accuracy tested ��'`6'��
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy