2015_1023 IRRIGATION DOMESTIC i-lRELINE X
The following fonn must be completed foi- each assembly tested. A signed and dated original
must be submitted to the public water supplier for recordkeepi��g pui-poses:
BAC�CFLOW PRE�FENTION ASSEMSLY'�EST��v'D 1RAI�iTE'V.�NCE REPORT
NAME OF PWS: CITY OF CQPPELL PWS I.D. #0�7004a
(Customer)
MAILII�G ADDRESS: 253 Gl�b Gircfe Dr Co��ell TX 75019
GONTACT PERSON/PHONE: ni 214- -0 3
LOCATION OFSERVICE: [�c�(�, S„„�,A „��,,,,o
The backflow prevention asscmbly detailed below has been tested and maint�ined as required by
commission regulations and is ccrtificd to be operating�vithin acceptable i�arainet�rs.
7'YPE OF ASSEIl��BLI'
Reduced Pressure Principle Reduced Pressure Princip(e-Detector
X Double Check Val��e Dozible Clieck-Detector
PressureVacuumBreaker Spi1l=Resistant Pi•essure Vacuum Breaker
Manufactui•er �F�,,�,�.5 i�Iodel Number �.��8 Size /��
Located At Q. Seri�►1 Nu�nher 1IolC9(o
Is the assemb y installed in accordance with manufacturer reconunendations andior local codes'? eS
Reduced Pressiare Princi le�4sse�nbhr Pressure Vacuum Breaker
Double Check Valve Assembly
Relief Val�=e Air Inlet Check Valve
I st Check 2nd Check
��,�j Held at 2.Z psid Neld at 1•� psid Opencd at Orcned at Held at
Initial Test C'losed T'ight✓ Closed Tight v psid psid psid
Leaked Leaked Did not open Did not open Leaked
Repairs/
Materials
Used
Held at psid Held at psid
Test After � Opencd at Opened at HeJd at
Repair Closed Tight ' Closed Tight psid psid psid
Test�auge used: Make/Model Anollo 40-200-tk5u SN: 04142867
Date Tested for Accuracy: 5/4/2015
Remarks:
The above is certified to be true at the time of testina.
Firm Name Diamondback Fire Protection Firnl Address PO Box 2507, Waxahachie,TX 75168
Certificd Tester{�„-:r:tl,loe Standridae Certitied Tester(signature)
Finn Phonc# (214)444-3194 Ceirt.Testcr No. BP0015823 I)ate 10/23/2015
�TEST RECORDS MUST BE KEPT FOR AT LEAST THREE 1'EARS
M�USE�NLY MANUFACTURER`S REPLACEA�ENT PARTS
White-City Copy �'elioiv-Customer�'opy Pink-Tester's Copy