2012_0509 (8)CIIECK ONE:
IRRIGATION_ I30MESTIC�_ FII2.ELIPPE
BACKFLOW PREVEflTiiOly ASSEl►•IBLY' TEST AND MfAIIVTEN"ANCE REPORT
NAME OF PWS: CITY OF COPPL'LL
PWS I.D. #
LOCATION OF SERVICE: US Postal Service, 951 W. Bethel Road
The bacl�Iow prevention ass�bty detailed below has been trsted and ma;.,rai„Cd as required by TNRCC
r=_¢ulations and is certified to be operating within acceptable parmmeters.
TYPE OF ASSEMBLY
Q Rcduccd Pressure Principle a Pressure Vaculmm Breaker
� Double Check Valve d Atmosphere Vacuum Breaker
Manufacturer Ames Size 4••
Model Number 2000 Located At
Sinai Number 1 012E02
Riser #H3
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BRRAKFR
Double Check Valve Assembly
1st Check tad ChecL Relief Valve Air Inlet Check Valve
Initial Test DC- Closed Closed Tight ✓Q
Opined at Opined at
nsid
Tig� 0 � Leaked o
nsid nsid
RP- nsid
Leaked n 2-6
Did not Opm Q
Leaked �
Repairs
and
Materials
Used
Test AiTrr DC- Closed Closed "light Q
Opened at Opened at
nsid
Repair Tight O
nsid nsid
ItP sid
The above is certified to be true.
Firm Name Professional Backflow
Firm Addcrss 5068 Avery, The Colony
Gauge � 372461
llate last accuracy tested 03/03/12
Certified Z.�� Scott Masdon ��
Cent Tester No. 2524 Date 05/09/12
White — Customer's Copy Yellow —City Copy Pink — Tester's Copy