2012_0509 (2)CIIECK ONE:
IRRIGATION DOMESTIC�_�' FYRELINE
BACI�'LOW PREVENTION ASSEMBLY" TEST AIVD M.4I2VTENANCE REPORT
NAME OF PWS: CITY OF COPPiLL
PWS I.D. #
LOCATION OF SERVICE: US Postal Service, 951 W. Bethel Road
The bacicIIow prcvmtion assmibly � derailed below has been tested and ma;*+ra;r,ed ag r� �, TNRCC
re_eulano, ^� and is certified to be operating within acceptable parameters.
TYPE OF ASSEMBLY
0 Reduced Pressure Principle a Pressure Va��****� $reaker
0 Double Check Valve � Atmosphere Vacuum Breal;Q
Maaufactiscr Hersey Size 4"
Mode3 Number DC Located At Riser # 5
Serial Number 8019824
The above is certified to be true.
Firm Name Professional Backflow C�Sed Tester Scott Masdon
��
F� Address 5068 Avery, The Colony Cert. Tester No. 2524 Dam 05/09/12
Gauge # 372461
Date last accuracy tested 03/03/12
White - Customer's Copy YeIIow -City Copy Pink - Tester's Copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VACUUM B���A
Double Check Valve Assembly
1st Check
Sad Check
Relief Valve
Air Inset
Check Valve
Initial Test
DC- Closed
Closed Tight ✓�
Opened ai
Opened at
osid
Tight3 �
Leaked O
nsid
osid
2
RP- 3 osid
Lccaed a
3-O
Did not Opea o
Leaked �
Repairs
at:d
Materials
Used
Tart Aiirr
DC- Closed
Closed 'tight a
Opened at
Opened at
_nsid
Repair
Tight O
nsid
nsid
RP std
The above is certified to be true.
Firm Name Professional Backflow C�Sed Tester Scott Masdon
��
F� Address 5068 Avery, The Colony Cert. Tester No. 2524 Dam 05/09/12
Gauge # 372461
Date last accuracy tested 03/03/12
White - Customer's Copy YeIIow -City Copy Pink - Tester's Copy