2014_0603 (4) I
CIIECK ONE: D^
IRRIGATION_ DOMESTIC I / >< .... 1 FLRELINE I 3r
BACKPI.OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
Y.
PWS I.D. ii
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 0 Pressure Vactn Breaker
- }T� ` � Double Check Valve O Atmosphere Vacuum Breaker
Manufactttrer Watts Size 1"
Model Number 009 Located At small cooling tower
Serial Number 59725
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER
Double Check Valve Assembly
1st Check 2nd Check Relief Valve Air Inlet Check Valve
Initial Test D t - Closed Closed Tight Opened at
Tight L eaked o id p sid _Find
RP 1: a psid l —�
Leaked o � d Did not Open o Leaked Q
Repairs
and
Materials
Used
Test After DC- Closed Closed Tight o Opened at Opened at psid
Repair Tight 0 psid psid
RP psid
The above is certified to be true. �� ��
Firm Name Professional Backflow Certified Tester Scott Masdon
Firm Addrwss 5068 Avery, The Colony Cert. Tester 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