2013_0606 (6)CHECK ONE:
IRRIGATION DOMESTIC—J:� FIRELINE.��
BACKTLOW PREVENTION ASSEMBLY TEST AND KAiNTEN1ANCE REPORT
I
NAME OF PWS: CITY OF COPPI;LL
PWS I.D. #
LOCATION OF SERVICE: US Postal Service, 951 W. Bethel Road
The backflow prevention assembly detailed below has been tasted and maintained as required by TNRCC
regulations and is certified to be operating within acceptable parameters.
❑ Reduced Pressure Principle
0 Double Check Valve
Manufacturer Hersey
Model Number DC
Serial Number 8019824
TYPE OF ASSEMBLY
e Pressure Vacuum Breaker
Atmosphere Vacuum Breaker
Size4,1
Located At Riser # 5
The above is certified to be true.
Firm Name Professional Backflow
Firm Address 5068 Avery, The Colony
Gauge # 372461
Date last accuracy tested 03/03/13
Catified Testa Scott Masdon 9--L
Cart 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
tad Check
Relief Valve
1 Air Inlet
Check Valve
Initial Test
DC- Closed 3.2
Closed Tight 2]
Opened at
Opened at
nsid
Tight 0
Leaked 0
_—_—psid
psid
RP -- _ -psid
Leaked 0
3 0
Did not Open o
Leaked 0
Reps
and
Materials
Used
Test After
DC- Closed
Closed Tight 0
Opened at
Opened at
asid
Repair
Tight 0
"psid
_ _psld
RP sid
The above is certified to be true.
Firm Name Professional Backflow
Firm Address 5068 Avery, The Colony
Gauge # 372461
Date last accuracy tested 03/03/13
Catified Testa Scott Masdon 9--L
Cart Testa No. 2524 Date 06/06/13
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy