2015_1023 IRRIGATION DOMEST►C F!RELINE X
The following farm must be completed for eacll assembly tested. A �igned and dated original
must be submitted to the public water supplier for i•ecordkeeping ptu-poses:
BACKFLOW PRE�'ENTION.�SSEMBLY TEST,�1�D M��,I�m'TE'VA!�iCE REPORT
NAME OF PWS: CITY OF CQPPELL PVvS I.D. #Q�70040
(Customer)
MAILING ADDRESS: �53 Club Circle Dr. CoR�ell TX 75019
CONTACT PERSOiv'/PHONE: i 214- -
LOCATION OF SERVICE: I(��Iq T� ��o
The backflow prevention assembly detailed belo���l�as been tested and maintained as required by
commission regulations and is certified to be operating evithin accept�blc��aramet�rs.
TYPE OF��SENI�L�'
Reduced Pressure Principle Reduced Pressure Principle-Detector
X Double Check Valve Double Check-Detector
PressiucVacuumBreaker Spill=Resistant Pressure Vacuum Breaker
Manufacturer��,¢_ti tYlodel Number 2F•Y.nO�P, Size 1"
Located �1t ��a.n.�- Serial Ninnbec 13a12�
Is the assembly installed m accordance u�ith mauufactiu-er recommendations ancUor local codes'?
Reciuced Pressure Princi le Assembhr Pre�sure Vacui�i»Breaker
Double Check Valve Assembly
I st Check � Relief VahTe Air Inlet Check L'alve
nd Check
CM�g Held at 1•�psid He1c1 at 1_�psid O�en�d at__ Qprncd at Hcld at
� Initial Test Closed Tight✓ Closed Tight ✓ psid p,i� ��yi��
Leaked Leaked Did not open L�id not open Leaked
Repairs/
Materials
Used
Held at psid H�Id at ��sid
Test After Opei�ed at Opened at Held at
Repair Closed Tight ' Closed Tight psid }�sid �sid
Test�auge used: Make/Model_�pllo 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.
Finn Namc Diamondbadc Fire Protection Firn1 Address PO Box 2507. Waxahachie TX 75168
Certitied Tester{�,r;��t�oe Standridae Certitied Tester(signat<<re)
Firm Phonc# (214)4443194 Cert.Tester No. BP0015823 [)ate 10/23/2015
'`TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS
�'� USE ONLY MANUFACTURER'S REPLACEYIENT PARTS
White-City Copy Yello�v-Customer Copy Pink-Tester's Copy