2016_1025_RPZ C�IECK ONE:
IRRIGATION DOMESTIC � FIRELINE
BACI�LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAI�OF PWS: CITY OF COPPELL
PWS I.D. # ���QD yD
LOCATION OF SERVICE: �1 � C-�p�� 1,�c�� C,oDD��. �v�[�l�l
The bacl�low prevmtion asscmbly detailod below has bean tested and maintained as required bv TNRCC
re�uladons and is cercified to be opera�ng within acceptable parametcrs.
� TYPE OF ASSEMBLY
Reduced Pressure Principle � Pressurc Vacu�Breaker
� Double Chcck Valve ❑ Atmosphere Vacuum Breaker
�0l
Manufactiaer �/lI�-�:� Siu
Model Number Ci�j� Locaud At ��%`� /`!d P�/�DO�.
Serial N�ber �� -(D vr '1 D _
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V�CUUM BRF.�►I�R
Double Check Valve Assembly
lst Cherk lnd C3ecl: Relief Valve Air Inlet Checic Val�'e
Iaival Test DGClosed Closed Ti�� Opeaed at OPeaed at °s�d
� Tight�o,� � Leal:ed � �_psid usid
� b S Rp =Psid
�� ❑ Did not Opea o L,eal:ed �
�P�
and
Materials
Used
Test Aftet DC-Closed Closed Tight o Opeae�at Opeaod at °s�d
Repair Tight o �sid __flsid
Rp sid
The above is certifiod to be true.
Firm Name�-�� h .�uG�rCQ .�-NC� Certifiiod Testa , . �h �(4 �°��S
Firm Address��6 /�I�.f�r�r►4,L �Q�t Cat Testa No Date a�S- �
Gauge # C'���� �.t7{'��
llate last accuracy tested ���- �"'�S
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy