2012_0509 (6)! CIIECK ONE: �j�
IRRIGATION_ DOMESTIC � �/ � FIRELINE
� BACI{F'LOW PREVEl�i'ITIDN ASSEIrIBLY TEST A2VD CE REPORT
NAME OF PWS: CITY OF COPP�L L
I
PWS I.D. #
LOCATION OF SERVICE: US Postal Service, 951 W- Bethel Road
The bacictlow prcvmtio�n assmzbly detailed below has been tested and mainta;ncd as rtq�tzd by TNRCC
regttlacio�ns and is certified to be operating within acceptable paramcrus-
TYPE OF ASSEMBLY
Q Reduced Pressure Principle c Pressure Vacutrm Brcalaer
� Double Check Valve C Atmosphere Vacuum Brealter
Manit{dCL1Ser Wilkins $iZP. 4••
Model Number 350A Located At Riser #1
Serial N>mtber 415061
The above is certified to be true.
Firm Name Professional Backflow
Firm Addrzss 5068 Avery, The Colony
Gauge � 372461
Date last accuracy tested 03/03/1 2
Certified Tester Scott Masdon �/
v
Cert. Tester No. 2524 Dare 05/09/12_
White - Customer`s Copy Yellow -City Copy Pink - Tester's Copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
+PRESSURE VACUUM BRF StifFR
Double Check V alve Assembly
Ist Check 2nd ChecL Relief Valve
Air Inlet Cbeck Valve
Iainal Test
DC- Closed Closed Tight Q Opined at
Opined at nsid
Tig{at 0 Leaked C nsid
nsid
RP- 4-8 nsid
4.8
Leaked D
Did not Open C Leaked O
Repatrs
and
Materials
Used
Test Aiiu
DC- Closed Closed Tight � Opined ai
Opined at nsid
Repair
Tight D nsid
nsid
RP sid
The above is certified to be true.
Firm Name Professional Backflow
Firm Addrzss 5068 Avery, The Colony
Gauge � 372461
Date last accuracy tested 03/03/1 2
Certified Tester Scott Masdon �/
v
Cert. Tester No. 2524 Dare 05/09/12_
White - Customer`s Copy Yellow -City Copy Pink - Tester's Copy