2015_1023 IRRIGATION DOMESTIC FlRELINE X
The following form inust be completed for each asseinbly tested. � signed and dated original
must be subinitted to the public water suppiier for recordkeeping p�.►i-poses:
BACKFLOW PREVENTION,4SSEMBLY TEST Al�`D V[.�I�TENANC� REPORT
NaME oF Pws: CITY OF COPPELL Pws I.D. #05700�0
(Custon�er)
MAILING ADDRESS: _�53 Club Circle Dr Coq�ell TX 75019
CONTACT PERSON;PHONE: Denise 214-930-0933
LOCATION OF SERVICE: /o � 'y--,��e�,�n�e
The backflow prevention assembly detailed belour has been tested and maintained as required Uy
commission regulations and is certificd to be operating�rithin acceptabie��aramzters.
TI'PE OF A55E1�$�LY
Reduced Pressure Principle Reduced Pi•essiire Priuciple-Detector
X Double Clleck Valve Do�ibie C11ecl:-Detector
PressurcVacuumBreaker Spi1l=Resistant Pressure Vacuum Breaker
Manufacturer /�-F�g �lodel Numbe!- 2!C`kS�D� Size 1°
Located At Serial Number I,lo l l'}-
Is the assembly installe in accordance with manufacturer recommendations and/or local codes'?
Reduced Pressure Princi le Assembh� Pressure Vacuum Breaker
Double Check Valve Assen�bly
1 st Check � Relief Valve Air Inlet Check Valve
nd Check
��5 Held at�.�psid Held at��o psid Opened��t Opei�ed at Held at
� Initial Tcst Closed T'ight ClusedTight psid psid psid
Leaked Leaked . Did not open Did not open Leaked
Repairs/
Materials � �
Used
Held at psid Held at psid
Test After Opened at ' Opened ai Held at
Repair Closed Tight i Closed Tight ps�d ps��{ psid
Test�auge used: Make/Model oll0 40-200-tk5u SN: 04142867
Date Tested for Acctu�acy: 5/4/2015
Remarks:
The above is certified to be true at the time of testina.
Firm Name Diamondbadc Fire Protection Finn Address PO Box 2507. Waxahachie TX 75168
CertiticdTestc�•(�r�±-.t1�oeStandridae CertitieciTestei-(signaturi)
Finn Phonc#_{214)444-3194 Cert.Tester No. BP0015823 _ Date 10/23/2015
'�TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS
�� USE ONLY MANUFACTURFR'S REPLACEMENT PARTS
White-City Copy Yello�v-Customer Copy Pink-Tester's Copy