2014_0603 (5) CHECK ONE: RV
IRRIGATION_ I.
DOMESTIC FIREINE I
I
BACKFLOW 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 bacldlow prevention assembly detailed below has been tested and maintained as required by TNRCC
regulations and is certified to be operating within acceptable parameters.
0 TYPE OF ASSEMBLY
Red Pmstrre Pr i n ciple 0 Pressure Vacuum Breaker
Double Check Valve O Atrnosphere Vacuann Breaker
Watts
Manufacaer Size 3/4"
n
Model Number 909HW Located At Boiler
Serial Number 27613
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BRFwrrFR
Double Check Valve Assembly
1st Cheek 2nd Check Relief Valve Air Inlet Check Valve
Initial Test DC- Closed Closed Tight :in Opened t Opened at psid
Ti Leaked ❑ 7 � nsid ______psid
RP 4- -nsid Q�
Leaked ❑ O - 0 Did not Open o Leaked ❑
Repairs
and
Materiais
Used
Test After DC- Closed Closed Tight a Opened at Opened at _nsid
Repair Tight ❑ psid :mid
RP____,
The above is certified to be true.
Firm Name Professional Backflow Certified Tester Scott Masdon
Firm Address 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 Pinic - Tester's Copy