2012_0509 (4)CIIECK ONE:
IRRIGATION_ __ DOMESTIC_ FIRELINE
BACKFI..OW PREVENTION ASSEMBLY TEST AND ItvlAilVTEN'ANCE REPORT
NAME OF PWS: CITY OF COPPEI,L
PWS I.D_ #
LOCATION OF SERVICE: US Postal Service, 951 W. Bethel Road
The bacl. -flow prevention assmsbly deeailed below has bcm trstod and r*+a�*+ra;,,ed � �quited by TNRCC
re_eulatio�ns and is certified to be operating within acceptable parameters_
TYPE OF ASSEMBLY
Q RcducVd Pressure Principle a Pressure Vacuum Breakrr
Q Doubic Check Valve a Atmosphere Vacuum Breaker
Maaufacttaer Ames Sim g^
Model Number 2000 Located Az Riser # 7
Serial Number 1208E06
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BQrsrrFu
Double Chock V alve Assembly
1st Check Zad Checl: Relief Valve Air Inlet Cheek Valve
Initial Test DC- Closed Closed Tight Q✓ Opined at Opened at osid
Ti�at � Leaked O vsid vsid
RP- 4-O vsid
Leaked [7 3-8 Did not Open o Leaked '�
Rcpaus
and
Materials
Used
Test ARu DC- Closed Closed Tight o Opened at Opmad at vsid
Repair Tight o vsid vsid
IZP sid
The above is certified to be true.
Firm Name Professional Backflow Ces�tified Tester Scott Masdon
Firm Address 5068 Avery, The Colony Cent Tester No. 2524 Dam 05/09/12
Gauge # 372461
Date lest accuracy tested 03/03/12
White — Customer's Copy Yellow —City Copy Pink — Tester's Copy