2014_0603 (2) CHECK ONE:
IRRIGATION_ DOMESTIC I I FIRELINE I ✓
BACTCFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF CORRELL
l
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.
TYPE OF ASSEMBLY
0 Reduced Pressure Principle 0 Pressure Vacuum Breaker
0 Double Check Valve O Atmosphere Vacuum Breaker
Manufacturer Watts Si 3/4"
Size
Model Number 709 I a. - aced At Riser # 1
Serial Nummber 161420 Serial
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 3 _co Closed Tight rill Opened at Opened at psid
Tight Leake O ______psid _psid
RP- nsid
Leaked o a _ --- Did not Open O Leaked rJ'
Repairs
and
Matcials ,
Used
Test After DC- Closed Closed Tight O Opened at Opened at --psid
Repair Tight o psid nsid
R F _Psid
The above is certified to be true.
Firm Name Professional Backflow Certified Tester Scott Masdon S
C.
Firm Address 5068 Avery, The Colony Cent Tester No. 2524 Dsr^ 06/03/14
Gauge F 002013
Date last accuracy tested 03/03/14
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy