RPZ_2015_0421 C�IECK O1dE: � � �
LRItIGATION DOMESTIC ,,/ FIRELINE
BACIQ�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. # �,�he��� '�Lvi,-
LOCATION OF SERVICE: Sy('o. E. S�tiii�� I�,d(� �?r�
The bac1.-tlow prevmtion asscmbly detailed below has beea tested aad n'+a��t �ned as required by TNRCC
regulauons aad is certified to be opaating within acceptablc paramcters.
/ TYPE OF ASSEMBLY
d R�duced Pressure Principle � Pressvrc Vacu�Breaker
^_ Double Chxk Valvc o Atmosphere Vacuum Breaker
Maaufacturer . C�`�5 Siu �'�
Model Nt�ber f�'7� r'h�.f`J� Locatcd At �°r� �",Sa-� C�r�t �2� �.�s'���
Seria!N�ber ,���o`I�{
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Double Check v alve Assembly
lst Check 2nd Chec]: Relief Valve :�ir Inlet Check Va1ve
Inival Test DGClosed Closed Ti;ht Opened at Opened at nsid
Tidit �,(� Lcal:ed ❑ �� `I �sid _nsid
�
� � RP-_psid ,a
Leal:ed � �i Did not Open O Leal►ed o
�P�
aad
Materials
Used
Test After DC-Closed Closed Tight o Opeaed at Opeaod at �sid
Repair Tight ❑ nsid __osid
R.P sid
The above is certified to be tzue.
�j�' � A �
Firm Name ��' F�O� �.,c�uL's-F� Certifiod Testc i ��
Firm Address� ��• 11'�o dn i r��r�fl,G�� Cat Tester Na � �� � Date -�/.f
�"x 7�e�S
cauge #�`o�fl�N�'�_
llate last accuracy tested �a„- ��- l y
White - Customer's Copy Yellow - City Copy Pink-Tester's Copy