2017_0316_RPZ CHBCK ONE:
IItRIGATION DOMBSTiC ✓ FIR8LIN8�
BAQ�'LOW PREVENTION ASSEMBLY TES?AND 11sA�V1TNArTCE RLppRT
NA1vME OF PWS: �'l�'O�'COPPELL
PWS LD.�! Valley Ranch Baptist Church
LOCAT'ION OF SERVICE: 150� E Be�t�ine Ra copPeu 7s7 os
The baci�low pz+evention assembly detailed below bas baa tested and maiataiaed as iequirad bv TNRCC
regnlations aod is catified to be opaatiag within acceptabk paramcters.
� TYPE OF ASSEIVIDLY
Rtduce�Pressurt Ftiaciple e Pres�ue V�Breaker
o Double Check Vatve ❑ At�spbae Vacuum Breaker
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�G-t� s� a►�Z.
Model Number `7�g Located At /l2��_L�_ /1.,-� c.�S.r�c '
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Serial xumber /�G n7 0� �
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REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSiJRE V�CUUM BRFAI�R �
Doubie Cheeic Valve Assembly � i
lst C3eck 2nd Check Rdief Valve tir ldet Cheek Vah+e '
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Iaidal Test DC-Closod Close�i Tight �( at � Qpeaed at _gs°
Tight�2 Leal►ed a (j .�p � d
sid _�es�
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k� o Did aot Open o Leaked o �
RtPaus
aad
Macaiata
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Test ABer DC-Closed Clased Tight o pp�� � �
Repair Tight a ,�psid sid �� 4
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T7�e above ia catified to be ocue. +
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Fie�mName 1-A Fire&Domestic Testihq �?� Jeremy Richards , i
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F"1��PO Box 79548 Fort Worth Texas 76179 Cert,Teatc No. _BP0011462 j��4/7
Gau�e � 0073178
Date last accuracy tested 12/2/16
White-Customee�s CopY Yeuow-city copy Pink—Te�ter's Copy
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CHECK ONB:
IR$IGATION DO�lESTIC FIRBLINS_�`
BACi�+'LOW PREVENTlON A5SE14�LY TFSr AND MAWI'ENANCE REppgT
NAIiME OF PWS: �'I�'OF COPPELL
PWS I.D.�! Valley Ranch Baptist Church
j,QCA�Qj�j QF$��CE: 1501 E Beltline Rd Coppell 75109
�C b�OW �fCVC0�0II LSSCmb� dGLallOd �OW �5 bCCI tCS� � II'1�1nY81II0� aS I�qtlllCd �'V �jtCC
regnlarions and is cectifiod w be opaating withia accxptabk parameters.
TYPE OF ASSENiBLY
� Reduced Pr�ssmre Priaciple e Pressure V�Breaber
a Double Cbock Vatve ❑ Anaosphae Vacuum Bneaker
Manufacttaer l,i�i��►ng Siu o7"
1Vlod�el N�ber �I'�� Located At /� �•��� i
Seriat N�ber 6✓f,9G/�'i.3 ' i
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACiTUM BREAI�R ;
Doubie Cbecic V alve Assembly
��cb� �a t� x�v� ,���c c�v�
Initial Test DC-Closed Closed Tight � at . ppe��ffi I
Ti�ht Leal►cd {�x�psid ��
� ' _-_.Fsid
R.P- •
Leal;ed o Did not Open o Leaked c i
�P� I
aad 1
Mate:iala !
' Usod �
Tat A�r DC-Closed Closed Tight o Qp��� p�� '
Repsic Tight o __nsid __nsid �d �
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Tbe�bove ia ce�i6ed to be tnu. �
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Fiem Name 1-A Fire& Domestic Testi�q C��T� Jeremy Richards , i
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F'3��PO Box 79548 Fort Worth Texas 76179 C�rt,T�No. _BP0011462 �� �-��."�7
Ga� � 0073178
Date]sst accuracy tested 12/2/16
White—Customer's Copy Yellow —City Copy p�_T�� �y
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