RPZ_2015_1124 C�IBCK ONE:
IRRIGATION DOMESTIC � FIRELINE�
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINI'ENANCE REppRT
NAME OF PWS: CITY OF COPPELL
PWS I.D. # �
LOCATION OF SERVICE: //Z /�• /�� j� �oL�
The bacl�low prevmtion asscmbly detailed below has beea tested aad maintained as requircd b�, T'NRCC
reguladons aad is certified to be operating within acceptable parameters.
/ TYPE OF ASSEMBLY
e� Reduced Pressure Principle ❑ Pressvre Vacui�Breaker
❑ Double Chxk Valve o Amiosphere Vacuum Breaker
/ ,,
Manufactiaer Siu /L
Model Iv�ber S'���'13�T Located At �'t�n o-�A��.Z/'���'
Seriai N�ber �eBC�
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Double Check v alve Assembly
lst Check 2nd Checl: Reiief Valve Air Inlet Checic Valve
Inidal Test DGClosed losed Tight O�ened at Opened at osid
Ti�t Leal:ed o 3 d nsid __nsid
RP-] -�Dsid
S,S L,eal:ed o �� � Did not Opea o Lealce� �
�P�
and
Materials
Used
Test Afttr DC-Closed Closed Tight o Opeaod at Openod at �sid
Repair Tig�t o _csid _osid
RP sid
The above is catifiod to be we.
Fi:m Name � Certifiad Tester �fC�'�A"� Y���
Firm Ad � , � 1�Cert. Tester No. Date_1�s
7�ac�.s'
Gauge # � ,0 LeP'
llate last accuracy tested Z- y ~/
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy