2013_0606_RPZ (4)CHECK ONE:
IRRIGATION DOMESTIC
FIRELINE_ j
BACKnOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
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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
regulations and is certified to be operating within acceptable parameters.
TYPE OF ASSEMBLY
❑
✓ Reduced Pressure Principle a Pressure Vacuum Breaker
❑ Double Check Valve O Atmosphere Vacuum Breaker
Manufacturer Watts Size 3/411
Model Number 009M2 Located At VMF
Serial Number 199922
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
Catfied Tent Scott Masdon
Cart. Testa 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 Cheek Valve Assembly
1st Check
2nd Check
Relief Valve
Air Inlet
Check Valve
Initial Test
DC- Closed
Closed Tight ❑✓
Opened at
Opened at
osid
—�
Ti P-
Leak C3
Leak-ad
2.4 nsid
_ _psid
RP�,�- „•paid
7.0
Leaked ❑
Did not Open o
Leaked
RzPairs
and
Materials
Used
Test After
DC- CIosed
Closed Tight ❑
Opened at
Opened at
- --nsid
Repair
Tight ❑
_ —Psid
nsid
RP aid
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
Catfied Tent Scott Masdon
Cart. Testa No. 2524 Date 06/06/13
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy