2013_0606! CHECK ONE:
IRRIGATION DOMESTIC...J FIRELINE"
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: US Postal Service, 951 W. Bethel Road
The backftow prevention assembly detailed below has been tested and maintained as required by TNRCC
regulations and is certified to be operating within acceptable parameters.
TYPE OF ASSEMBLY
❑ Reduced Pressure Principle a Pressure Vacutn Breaker
❑✓ Double Check Valve ❑ Atmosphere Vacuum Breaker
Manufacturer Watts Size 3/4"
Model Number 709 Located At Riser #1 expansion tank
Serial Number
161420
The above is certified to be true.
Firm Name Professional Backflow Certified Tester Scott Masdon
Firm Address 5068 Avery, The Colony Cat Tester No. 2524 Date 06/06/13
Gauge # 372461
Date last accuracy tested 03/03/13
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VACUUM BREAKER
Double Check Valve Assembly
1st Check
2nd Check
Relief Valve
Air Inlet
Check Valve
Initial Test
DC- Closed 1.6
Closed Tight ❑✓
at
t�sid
Opened at
_ —. d
Tight 0
Leaked ❑
, —nsid
RP- ,.psid
Leaked ❑
1 '4
Did not Open ❑
Leak-ed ❑
Repairs
n
rials
After
DC- Closed
Closed Tight ❑
Opened at
Opened at
Wald
ir
Tight ❑
nsid
psid
RP Sid
The above is certified to be true.
Firm Name Professional Backflow Certified Tester Scott Masdon
Firm Address 5068 Avery, The Colony Cat Tester No. 2524 Date 06/06/13
Gauge # 372461
Date last accuracy tested 03/03/13
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy