2014_0603 (7) CHECK ONE:
IRRIGATION DOMESTIC I I FIRELINE I ✓ I
i
RACE FLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT' /
NAME OF PWS: CITY OF' COPPELL
PWS LD. #
LLO- CA�T�I�O1N OF SERVICE: US Postal Service, 951 W. Bethel and The LOCATION
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
Q Reduced Pressure Principle a Pressure Vaclmn Breaker
M✓ Double Check Valve ❑ Atmosphere Vacuum Breaker
Manufacturer Hersey S1ze 4"
Moel Number DC meted A Riser # 6
d
Serial Number 8019880
'
REDUCED PRESSURE PRESSURE �
RE PRINCIPLE ASSEMBLY PESSUE VACUUM BAF� R
Double Check Valve Assembly
1st Check Sad Check Relief Valve Air Inlet Check Vah+e
Initial Test DC- Closed Closed Tight � Opened at Opened at paid
Ti� _ eaked a osid osid
RP -✓ id
t 1
•
Leaked o d Did not Open ❑ Leaked ❑
Repairs
and
Materials
Used
Test Arta DC- Closed Closed Tight ❑ Opened at Opened at osid
Repair Tight o osid psid
RP osid
The above is certified to be true.
Firm Name Professional Backflow Coed Tester Scott Masdon
Firm Address 5068 Avery, The Colony Cert. Tester No. 2524 fi ate 06/03/14
Gauge # 002013
Date last accuracy tested 03/03/14
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy