2014_0603 (9) CHECK ONE:
IRRIDATION DOMESTIC I I FLRELINE I ✓
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF CORRE'LL
)4
PWS LD_ #
LOCATION OF SERVICE: US Postal Service, 951 W. Bethel Road
The back low prevention assembly detailed below has been tested and mAinra;ned as required by TNRCC
regulations and is certified to be operating within acceptable parameters.
TYPE OF ASSEMBLY
0 Reduced Pressure Principle c Pressure Vacuum Breaker
0 Double Check Valve o Atmosphere Vacuum Breaker
Manufacturer `°�� �P^ Size 4
u '
Model Located At Riser # 4
Serial Number _ / — 7-1- 3 7
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER
Double Check Valve Assembly
1st Check 2nd Check Relief Valve Air Inlet Check Valve
Initial Test DC- Closed Closed Tight MS Opened at Opened at psid
Tis�j / � Leaked O nsid nsid
RP j f O nsid
Leaked D � � Did not Open o Leaked J
Repairs
and
Materials
Used
Test After DC- Closed Closed Tight o Opened at Opened at nsid
Repair Tight O nsid nsid
RP nsid
The above is certified to be true.
Firm Name Professional Backflow C fi� Tester Masdon
Firm Address 5068 Avery, The Colony Cert. Tester No. 2524 arc 06/03/14
Gauge # 002013
Date last accuracy tested 03/03/14
White - Customers Copy Yellow - City Copy Pink - Tester's Copy