2014_0603 (6) CIIECK ONE: �'il
IRRIGATION_ DOM L
ESTIC FIREINE1 i`
BACICFLOW PREVENTION ASSEMLBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. ii
LOCATION OF SERVICE: US Postal Service, 951 W. Bethel Road
The back:low prevention assembly detailed below has been tested and maintained as
regulations arid is certified to be operating within acceptable parameters_' by TNRCC
TYPE OF ASSEMBLY
Reduced Pressure Principle 0 Pressure Vacuum Breaker
Double Check Valve o Atmosphere Vacuum Breaker
Manufacturer Watts Size 3 Manufacturer
Model Number 909HW Located At Chiller
Serial Number 27612
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BRFSICER
Double Cheek Valve Assembly
1st Check 2nd Check Relief Valve Air Inlet Check Valve
Initial Test DC- Closed Closed Tight j,EI Opened at
Opened at paid
Ti {� Leaked Q � Z psid osid
P� 1S�� p aid
t 'i"� R o O G
- Did not Open o Leaked o
Repairs
and
Materials
Used
Test Attar DC- Closed Closed Tight o Opened at Opened st osid
Repair Tight 0 osid osid
RP---Paid
The above is certified to be true.
Firm Name Professional Backflow Certified Testa Scott Masdon dir
Firm Address 5068 Avery, The Colony Cart Testa No. 2524 Dare 06/03/14
Gauge # 002013
Date last accuracy tested 03/03/1
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy