2013_0606_RPZ (2)CHECK ONE:
IRRIGATION'
DOMESTIC — � FIRELINE���
13AMLOW 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 backflow prevention assembly detailed below has been tested and maintained as required by TNRCC
re_auiazions and is certified to be operating within acceptable parameters.
TYPE OF ASSEMBLY
0 Reduced Pressure Principle ❑ Pressure Vacuum Breaker
❑ Double Check Valve ❑ Atmosphere Vacuum Breaker
Manufacturer Watts Size 3/4"
Model Number 909HW Located At Boiler
Serial Number 27613
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
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
—�
Ti �F✓
Leaked
2.8 nsid
„_psid
RP•psid
8.4
Leaked C3
Did not Open ❑
Leaked ❑
Repairs
and
Materials
Used
Test After
DC- Closed
Closed Tight o
Opened at
Opened at
nsid
Repair
Tight ❑
, —psid
nsid
RP
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
Cent Tester No. 2524 Date 06/06/13
White - Customer's Copy Yellow - City Copy Pink - Tester -s Copy