2013_0613_RPZCHECK ONE:
IRRIGATION DOMESTIC FIRELINE ✓
BACKFLOW PREVENTION ASSEMBLY TEST AND MA ITENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: US Postal Service, 951 W. Bethel Road
The backnow prevention assembly detailed below has been tested and maintained as required by TNRCC
regulations and is certified to be operating within acceptable parameters.
M Reduced Pressure Principle
❑
Double Check Valve
Manufacturer
Watts
Model Number
009
Scrial Number
59725
TYPE OF ASSEMBLY
❑ Pressure Vacuum. Breaker
❑ Atmosphere Vacuum Breaker
Site1"
Located At small cooling tower
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
Certified Tester Scott Masdon
Cent. Tester No. 2524 Date 06/13/13
e
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE V ACUUM BREAKER
Double Check Valve Assembly
Ist Check
2nd Check
Relief Valve
Air Inlet
Check Valve
Initial Test
DC- Closed
Closed Tight ❑✓
Opened at
Opened at
�psid
Ti
%
2. 6 asid
,_psid
R•_psid
P
7.4
Leaked C3
Did not Open Q
Leaked) ❑
Repairs
and
/ Cv �
�'Ics
(�- V
L l�j C f
Materials
Used
Test ARa
DC- Closed
Closed Tight ❑
Opp at
Opted at
nsid
—�
Repair
Tight ❑
..- _- _ -_-nsd
trsid
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
Certified Tester Scott Masdon
Cent. Tester No. 2524 Date 06/13/13
e
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy