2013_0606 (8)CHECK ONE:
IRRIGATION DOMESTIC FIRELINEf 7`
BACIPLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: US Postal Service, 951 W. Bethel Road
The back-now prevention assembly detailed below has been tested and mamt=cd as required 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 Ames size 4
Model Number 2000 Located At Riser # 7
Serial Number 1208E06
The above is certified to be true.
Professional Backflow
Firm Name
Firm Address 5068 Avery, The Colony
Gauge # 372461
Date lest accuracy tested 03/03/13
Certified Test Scott Masdon
Tester
Cat Testa No. 2524 Dam 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
Ist Check
2nd Check
Relief Valve
Air Inlet
Check Valve
Initial Test
1 DC- Closed 3.8
Closed Tight [Z]
Opened at
Opened at
nsid
Tight [
Leaked ❑
nsid
,_- -_psid
RP -_psid
Leaked ❑
3'6
Did not Open ❑
Leaked ❑
Repairs
and
Materials
Used
Test After
DC- Closed
CIosed Tight ❑
Opened at
Opened at
nsid
Repair
Tight ❑
osid
nsid
RP sid
The above is certified to be true.
Professional Backflow
Firm Name
Firm Address 5068 Avery, The Colony
Gauge # 372461
Date lest accuracy tested 03/03/13
Certified Test Scott Masdon
Tester
Cat Testa No. 2524 Dam 06/06/13
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy