2013_0606 (7)! CHECK ONE:
IRRIGATION DOMESTIC__[� FIRELINE
I
BAC70LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPL'LL
PWS I.D. #
LOCATION OF SERVICE: US Postal Service, 951 W. Bethel Road
The backilow prevention assembly detailed below has been tested and maintained as regwred by TNRCC
regulations and is certified to be operating within acceptable parameters.
TYPE OF ASSEMBLY
❑ Reduced Pressure Principle ❑ Pressure Vacuum Breaker
✓❑ Double Check Valve ❑ Atmosphere Vacuum Breaker
Manufacturer Hersey size 4
Model Number DC Located At
Serial Number 8019880
Riser # 6
The above is certified to be true.
Professional Backflow
Firm Name
Firm Address 5068 Avery, The Colony
Gauge # 372461
Date last accuracy tested 03/03/13
Certified Tester Scott Masdon
Cat. Tester No. 2524 Dam 06/06/13
White — Customer's Copy Yellow — City Copy Pink — Tester's Copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE V ACUUM BREAKER
Double Check Valve Assembly
1st Check
2nd Check
Relief Valve
Air Inlet
Check Valve
Initial Test
DC- Closed 2.6
Closed Tight 0
Opened at
Opened at
vsid
—�
Tight [Z]
Leaked ❑
vsid
r -_psid
RP- ----„psid
Leaked ❑
2.4
Did not Open Q
Leaked ❑
Reps
and
Materials
Used
Test After
DC- Closed
Closed Tight ❑
Opened at
Opened at
vsid
Repair
Tight ❑
osid
psid
RP sid
The above is certified to be true.
Professional Backflow
Firm Name
Firm Address 5068 Avery, The Colony
Gauge # 372461
Date last accuracy tested 03/03/13
Certified Tester Scott Masdon
Cat. Tester No. 2524 Dam 06/06/13
White — Customer's Copy Yellow — City Copy Pink — Tester's Copy