RPZ_2015_1209 C�IBCK ONE:
IRRIGATION DOMESTIC FIRELINE
BACT�LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REpORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: ���� f� �S' �i��'Z�� - �iU�t'?, F �S C..r•-.�.0 ��+.1c rc�
The bacl��low prevmtion asscmbly detailod below has beea tested aad maintained as nquir,ed b�, 'TNRCC
re_eularions and is cectified to be operating withia acceptable parameters.
TYPE OF ASSEMBLY
� Reduced Pressure Priaciple C Pressure Vacu�Breakcr
❑ Double Check Valve o Amnosphere Vacuum Breal:er
Manufacuaer L./tt�/"S Siu 5���� ��
Modei Iv�ber L-��� V�13 Located At ��0 t�� �''�L� ����
,
Scrial Ni�ber � � b �a
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Doubie Check v alve Assembly
lst Check 2nd Checl: Relief Valve Air Inlet Cbeck Va1ve
Inival Test DGClosed Closed Ti�ht ed at Opeaed at osid
�
Tight� � 1� Leal:ed o �sid __,nsid
RP-=�psid �y �
Leal:ed o �� ` Did not Opea o Leal;ed �
�P�
aad
Matarials
Used
Test ARer DC-Closed Closed Tight o pp��� pp��� osid
Repair Tight o _nsid _nsid �
RP sid
The above is certified to be true.
Firm Name Ol Accurac_y Backflow �
Cetifiod Testa ���r�n V�a_�,, �-avtrr,
9990 Barton Circle
Fi�mAdd�tss z•__..__ •r�v •►�n�� Cest TesterNo. i �C7v► ' 7 Date / ��-9-15
�
Gauge # U$����CU 1
llate Isst accuracy tested ��'�' �5
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy