2013_0606 (3)! CHECK ONE:
IRRIGATION DOMESTICJ FIRELINE
BACIGLLOW PREVENTION ASSEMBLY TEST AND MARMNANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE. Postal Service, 951 W. Bethel Road
The back-flow 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 Vacutnrt Breaker
0✓ Double Check Valve ❑ Atmosphere Vacuum Breaker
Manufacturer Hersey size 4
Model Number DC Located At Riser #2
Serial Number 8019883
The above is certified to be true.
Firm Name Professional Backflow
Firm Address 5068 Avery, The Colony
Gauge # 372461
Date last accuracy tested 03103/13
Certified Tester Scott Masdon
Cent. Testa No. 2524 Date 06/06/13
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 2.4
Closed Tight 0
Opened at
Opened at
i_ nsid
Tight Q
Leaked O
&A sid
`psid
RP -_psid
2 2
Leaked D
Did not Open C
LeaL-ed D
Reps
and
Materials
Used
Test After
DC- Closed
Closed. Tight o
Opened at
Opened at
__ nsid
Repair
Tight ❑
`psid
__psid
RP ------- Dsid
The above is certified to be true.
Firm Name Professional Backflow
Firm Address 5068 Avery, The Colony
Gauge # 372461
Date last accuracy tested 03103/13
Certified Tester Scott Masdon
Cent. Testa No. 2524 Date 06/06/13
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy