2013_0606_RPZI CHECK ONE:
IRRIGATION DONESTIC --� FIRELINE��
BAOaLOW PREVENTION ASSEMBLY TEST AND MAiNT D(ANCB REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE: US Postal Service, 951 W. Bethel Road
The bacldlow prevention assembly detailed below has been tested and maintained 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 Q Atmosphere Vacuum Breaker
Manufacturer acts size -3/41@ -- -
Model Number 909HW Located At
Serial Number 27612
Chiller
The above is certified to be true.
Firm Name Professional Backflow
Firm Address 5068 Avery, The Colony
Gauge 11 372461
Date last accuracy tested 03/03/13
Ca led Testa Scott Masdon
Cent. 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
ist Check
2nd Check
Relief Valve
Air Inlet
Check Valve
Initial Test
DC- Closed
Closed Tight ❑✓
Opened at
Opened at
nsid
Tigh� 4 ✓0
Leaked Cl
2.4 nsid
osid
RP- _..nsid
Leaked ❑
7'2
Did not Open ❑
Leaked ❑
Reps
and
Materials
Used
Test After
DC- Closed
Closed Tight ❑
Opened at
Opened at
nsid
Repair
Tight ❑
___,psid
psid
RP sid
The above is certified to be true.
Firm Name Professional Backflow
Firm Address 5068 Avery, The Colony
Gauge 11 372461
Date last accuracy tested 03/03/13
Ca led Testa Scott Masdon
Cent. Tester No. 2524 Date 06/06/13
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy