2015_1023 IRRIGATION DOMESTIC FIRELINE X
The following form must be completed for each asse�nbly testeii. A signed and dated original
must be submitted to the public water supplier for►-ecordkeeping p��rposes:
BACKFLOW PREVENTION.�SSEMBLY TES�'Al�'D l�.�d��'EN�NCE REPORT
NAME OF PWS: GITY OF COPPELL PV�%S LD. # 0�70040
(Customei-)
MAILING ADDRESS: 253 Gl�b Circle Dr Coppell TX 75019
CONTACT PERSON,PHONE: D i 214- -0
LOCATtON OF SERVICE:_/�,r'j".� t,�nl,ona ♦nt�r
The backflow prevention assembly detailed below has been tested and mairrt�ined as required by
commission re�ulations and is certitied to be operating�vithin acc�}�table�aramet4rs.
'�'YPE OF�1S��I�$BI.,Y
Reduced Pressure Principle Reducec� Pressure Principle-Detector
X Double Cl�eck Valve Double Check-Detector
Pressurc Vacut�m Breaker Spi1l=Resistant Pressure Vacuum Breaker
Manufactui-er �w.�� �Ylodel Number 2d9pb B Size�_
Located E1t c' _Serial Niunher !���7
Is the assembly installe ui acco2-dance with mauufactiu-er recomniendations andior local codes'?
Reduced Pressi{re Princi le Assemblv � Pressure�%acuum Breaker
Double Check Valve Assembly
Relief Valve Air Inlet Check Valve
1 st Check 2nd Check
�SS Held at �-g psid Held at t, lo p:+id C)�en�d at__ O�cned at Heid at
Initial Test Closed Tight✓ Clused Ti�ht ✓ psid psid psid
Leaked Leaked Did not open Did not open Leaked
Repairs/
Materials
Used
Held at psid Hcld at psid
Test Af#er Opcuc�d at Upened at Held at
Repair CJosed Tight ' Closed Tight psid psid psid
Test aauge 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 testiii�.
Fir7n Name Diamondbadc Fire Protection �'irnl Address PO Box 2507, Waxahachie.TX 75168
Certit7ed Tester{p�-;��.t)�oe Standridae Certitied Tester(si`�i�atiu-e)_
Finn Phonc# (214) 444-3194 Cert.Tester;�o. BP0015823 Date 10/23/2015
^�TEST RECORDS MUST BE KEPT FOR AT LEAST THREE 1'EARS
��`* USE ONLY MANUFACTURER'S REPLACEMENT PARTS
White-City Copy I'eliow-Customer Copy Pink-Tester's Copy