2012_0509 (3)CHECK ONE:
IRRIGATION_ DOiY[E57iC_�� FYREL1PiE
BACKFLOW PREVENTION ASSE1rIBY.'1C TEST AND NIAI2VT°EI�YANC•E REPORT
NAME OF PWS: CITY CiF C'OPPL'LL
PWS I.D. #t
LOCATION OF SERVICE: US Postal Service, 951 W. Bethel Road
The bacicIIow prcvmtion assoably detailed below has bem tested and .*ra;..ra ;ned a5 required by TNRCC
� regatlations and is cemfied to be operating within acceptable parameters.
TYPE OF ASSEMBLY
Q Rcduc.,d Pressure PriacipIc C Pressure Vactatmm $realoer
�✓ Double Check Valve C Atmosphere Vacuum Breaker
Manufacturer Hersey Si ?� 4••
Model Number DC Located At Riser # 6
Serial Number 8019880
The above is certified to be trtte-
Firm Name Professional Backflow
Firm Addz�s 5068 Avery, The Colony
Gauge � 372461
Date last accuracy tested 03/03/12
Ca�fiai TcsYer Scott Masdon /�-�
Cent. Testa No. 2524 Dare 05/09/12
White - Customer's Copy Yellow -City Copy Pink - Te_ster's Copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
+PRESSURE VACUUM SnF s�'4
Double Check ti alve Assembly
Ist Cheri: tad Chec3c Relief Valve
Air Inlet Cheek Valve
Initial Test
DC- Closed
Closed Tight Q✓ Opined at
Opined at osid
Ti� Q
Leaked O osid
osid
6
RP- osid
2-4
r rates 0
Did noc Opm o Leaked o
Rep airs
and
Materials
Used
Test AYirr
DC- Closed
Closed Tight � Opened at
Opined at osid
Repair
Tight o
osid
osid
RP sid
The above is certified to be trtte-
Firm Name Professional Backflow
Firm Addz�s 5068 Avery, The Colony
Gauge � 372461
Date last accuracy tested 03/03/12
Ca�fiai TcsYer Scott Masdon /�-�
Cent. Testa No. 2524 Dare 05/09/12
White - Customer's Copy Yellow -City Copy Pink - Te_ster's Copy