2014_0603 (3) CHECK ONE:
IRRIGA•ION DOMESTIC I I FIRELINE I ✓
I
BACICE PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT'
NAME OF PWS: CITY OF COPPEL L `
i
PWS I.D. t3
LOCATION OF SERVICE: US Postal Service, 951 W. Bethel Road
The bacidlow prevention assembly detailed below has been tested and maintained as required by TNRCC
regulations and is ccufied to be operating within acceptable parameters.
TYPE OF ASSEMBLY
Q Reduced Pressure Principle ❑ Press -ure Vacuum Breaker
Double Check Valve ❑ Atmosphere Vacuum Breaker
Manufacturer Ames Size g
Model Number 2000 L,n -ar.� At Riser # 7
Serial Number 1208E06
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BRt AuER
Double Check Valve Assembly
1st Check Sad Check Relief Valve Air Inlet Check Valve
Initial Test DC- Closed Closed Tight p Opened at Opened at paid
Tigh gi Leaked ❑ nsid nsid
RP- G nsid
Leaked ❑ Did not Open o Leaked a
Repairs
and
Materials
Used
Test After DC- Closed Closed Tight o Opp at Opened at osid
Repair Tight ❑ nsid nsid
RP_psid
The above is certified to be true.
Firm Name Professional Backflow Certified Testa Scott Masdon
Finn Address 5068 Avery, The Colony Cart Testa No. 2524 Date 06/03/14
Gauge i 002013
Date Last accuracy tested 03/03/14
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy