2013_0606 (5)CHECK ONE:
IRRIGATION _ DOMESTIC FIRELINEJ7;I]_
BAC 0LOW PREVENTION ASSEMBLY TEST AND MAEVITNANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: US Postal Service, 951 W. Bethel Road
The baekflow prevention assembly detailed below has been tested and maintained as required by TNR.CC
regulations and is certified to be operating within acceptable parameters.
TYPE OF ASSEMBLY
❑ Reduced Pressure Principle a Pressure Vacuum Breaker
71 Double Check Valve Q Atmosphere Vacuum Breaker
Manufacturer Hersey
Model Number
m
Serial N=ber not legible
Site 4„
Located At Riser # 4
The above is certified to be true.
Firm Nary Professional Backflow
Firm Address 5068 Avery, The Colony
Gauge # 372461
Date lest accuracy tested 03/03/13
Certifier/ Testa Scott Masdon
Cat Tester 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 0.0
Closed Tight ❑
Opened at
Opened at
nsid
Tight ❑
Leaked O
nsid
psid
RP -__ _,_psid
Leaked ❑
0.0
Did not Open ❑
Leaked ❑
Repairs
and
Materials
Used
Test Agar
DC- Closed
Closed Tight ❑
Opened at
Opened at
asid
Repair
Tight ❑
______„ psid
nsid
RP sid
The above is certified to be true.
Firm Nary Professional Backflow
Firm Address 5068 Avery, The Colony
Gauge # 372461
Date lest accuracy tested 03/03/13
Certifier/ Testa Scott Masdon
Cat Tester No. 2524 Date 06/06/13
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy