RPZ_2015_1124 C�IBCK ONE:
IRRIGATION DOMESTIC FIRELINE
BAC�'LOW PREVENTION ASSEMBLY TES?AND MAINTENANCE REpOR?
x�OF Pws: CITY OF COPPELL
PWS I.D. # ' �p/g�ci
LOCATION OF SERVICE: �G/ `������ ,(�,/J,�.
T3e bacl�-flow prevmtion assembly detailed below has been tested aad maintain� � nQ� �, �CC
regulauons aad is cerdfied to be operating within acceptable parameters.
TYPE OF ASSEMBLY
-� Reduced Pressure Principle C Pmsurc Vacu�Brealcer
❑ Double Chcck Valve ❑ Amnosphere Vacuum Breaker
Maaufact�aer Siu
�Z
Model N�ber �-��3 Locatad At ��"''�
Serial N�ber �J`��7�
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VAC[JiJM BREAI�R
Double Cbeck Valve Assembly
lst Check ?nd Checi: Relief Valve Air Inlet Check Va1ve
Ininal Test DGClosed losed Ti,,P.ht at Opened at osid
Tight Leal:ed o sid _�sid —�
RP- -�sid � .� �
Leal:od o Did not Opea o Leai:ed o
�P�
and
Mataials
Used
Test Aft,et DC-Closed Closed Tight o ppeaed at ppmed at n�d
_�
Repair Tight ❑ _csid osid
RP sid
The above is cestified to be tive.
Firm Name ��l` — , Catifiod Testa �-u./��
Firm � C-ert. Tester No. � �' Date //-Z.��
7�olps
c8uge # ��A`�l(�P f�
llate last accuracy tested Z -/ Z- /
White - Customer's Copy Yellow - City Copy Pink-Tester's Copy