2013_0606 (2)CHECK ONE:
IRRIGATION _ DOMESTIC = FIRELINE r (7
BACMOW PREVENTION ASSEMBLY TEST AND AL INTENANCE REPORT
NAME OF PWS: C1TY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE. US Postal Service, 951 W. Bethel Road
The bac.4ow prevention assembly detailed below has been tested and maintained as required by TNRCC
re- sulations and is certified to be operating within acceptable parameters.
TYPE OF ASSEMBLY
❑ Reduced Pressure Principle a Pressure Vacuum Breaker
✓0 Double Check Valve ❑ Atmosphere Vacuum Breaker
Manufacturer Wilkins size 411
Model Number 350A Located At Riser #1
Serial Number 415061
The above is certified to be true.
Firm Name Professional Backflow
Firm Address 5068 Avery, The Colony
Gauge g 372461
Date last accuracy tested 03/03/13
Certified. Tens Scott Masdon
Cent. Tester No. 2524 Date 06/06113
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VACUUM BREAKER
Double Check Valve Assembly
Ist Check
2nd Check
Relief Valve
Air Inlet
Check Valve
Initial Test
DC- Closed 4.6
Closed Tight ❑✓
Opened at
Opened at
osid
Tight [✓
Leaked ❑
psid
-_psid
RP -.- -- --psid
Leaked C3
4.4
Did not Open ❑
Leaked ❑
Reps
and
Materials
Used
Test After
DC- Closed
Closed Tight ❑
Opened at
Opened at
_psid
Repair
Tight a
--psid
osid
RP
The above is certified to be true.
Firm Name Professional Backflow
Firm Address 5068 Avery, The Colony
Gauge g 372461
Date last accuracy tested 03/03/13
Certified. Tens Scott Masdon
Cent. Tester No. 2524 Date 06/06113
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy