2012_0509 (5)CHECK ONE:
IRRIGATION DOMESTIC_ FIRELINE_�_
BACI�z.ow PREVEN'iloN ASSE1bIBI.Y T-Eb-T AND 1VIAINTIENANCE REPORT
NAME OF PwS: C_'ITY OF COPPELL
Pws I.D. #
LOCATION OF SERVICE: lJS Postal Service, 951 W_ Bethel Road
The bacldlow prevmtioa assembly detailed bcIow has bcea tested and .*+a *.,ra;,,ed as tzquired by TNRCC
tt_sulatio�ns and is certified to be operating withia acceptable parameters_
TYPE OF ASSEMBLY
Q Reduced Pressure Principle C Pressure Vactacmm 23reaker
✓� Double Check Valve ❑ Atmosphere Vacuum Breaker
MaIIUfacntrcr Watts S�9P 3/4"
Model I�iumba 709 Located At
Serial Number 16'1420
Riser #1 expansion tank
The above is certified to be tnae.
Firm Natnc Professional Backflow
Firm Address 5068 Avery, The Colony
Gauge � 372461
Date last accuracy tested 03/03/12
Certified Testez Scott Masdon �'
Cent. Tester No. 2524 Dam 05/09/1 2
White — Custotner•s Copy Yellow —City Copy Pink — Tester's Copy
REDUCED PRESSURE PRINCIPLE ASSE11 -LBLY I PRESSURE VACUUM
BAFST�'R
Double Check Valve Assembly
1st Check
tad Check
Relief Valve Air Inlet
Check Valve
Ininat Test
DC- Closed
Closed Tight 0
Opined at Opened at
nsid
Tight �
Leaked ❑
nsid nsid
RP- 1 -4 nsid
Leaked ❑
1 ' 6
Did aot Open ❑
Leaked ❑
Rcp airs
aad
Materials
Used
Test AR.er
DC- Closed
CIosed "fight o
Opined at Opined at
� sid
Repair
Tight ❑
nsid nsid
RP sid
The above is certified to be tnae.
Firm Natnc Professional Backflow
Firm Address 5068 Avery, The Colony
Gauge � 372461
Date last accuracy tested 03/03/12
Certified Testez Scott Masdon �'
Cent. Tester No. 2524 Dam 05/09/1 2
White — Custotner•s Copy Yellow —City Copy Pink — Tester's Copy