2014_0603 CIIECK ONE:
IRRIGATION DOMESTIC I l.
FIRfiINfi I 17. I
BACKFZOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS T.D. fil
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 Vac -mina Breaker
Double Check Valve ❑ Atmosphere Vacuum Breake
Man crater Watts Size 3/4"
Model Number 009M2 o a.ed At VMF
Located
Serial Number 1 99922
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER
Double Check Valve Assembly
1st Cheek 2nd Check Relief Valve Air Inlet Check Valve
Initial Test DC- Closed Closed Tight (C] Opeked_at/ Opened at paid
Tight ® Leaked ❑ I- '`'nsid psid
RP- Q sid
Leaked ❑ (p. Did not Open o Leaked ❑
Repairs
and
Materials
Used
Test After DC- Closed Closed Tight ❑ Opened at Opened at esid I
Repair Tight ❑ nsid nsid
RP_____psid
The above is certified to be true.
Firm Name Professional Backflow Certified Testa Scott Masdon 4
Firm Address 5068 Avery, The Colony Cert. Testa No. 2524 Date 06/03/14
Gauge # 002013
Date last accuracy tested 03/03/14
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy